{"hospital_name":"West Valley Hospital","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["West Valley Hospital"],"hospital_address":["525 Se Washington Street, Dallas, OR 97338"],"license_information":{"license_number":"14-1461","state":"OR"},"type_2_npi":["1245237486"],"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":"James Parr"},"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AgeRight","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Atrio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Regence Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Intercommunity Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Coordinated Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Yamhill County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Professional Component","code":"26","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AgeRight","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Atrio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Regence Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Intercommunity Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Coordinated Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Yamhill County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Item or service expected to be denied as not reasonable and necessary","code":"GZ","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AgeRight","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Atrio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Regence Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Intercommunity Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Coordinated Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Yamhill County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AgeRight","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Atrio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Regence Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Intercommunity Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Coordinated Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Yamhill County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AgeRight","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Atrio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Regence Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Intercommunity Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Coordinated Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Yamhill County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AgeRight","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Atrio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Regence Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Intercommunity Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Coordinated Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Yamhill County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AgeRight","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Atrio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Regence Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Intercommunity Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Coordinated Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Yamhill County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AgeRight","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Atrio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Regence Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Intercommunity Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Coordinated Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Yamhill County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AgeRight","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Atrio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Regence Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Intercommunity Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Coordinated Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Yamhill County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"State supplied vaccine","code":"SL","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AgeRight","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Atrio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Regence Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Intercommunity Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Coordinated Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge 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standard charge value."},{"payer_name":"Intercommunity Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Coordinated Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Yamhill County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Service not related to the hospice patient's terminal condition","code":"GW","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AgeRight","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Atrio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Regence Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Intercommunity Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Coordinated Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Samaritan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Yamhill County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Via interactive audio and video telecommunication systems","code":"GT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AgeRight","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Atrio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Regence Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice Health Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Intercommunity Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Coordinated Care Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pacificsource","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge 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SURG","code_information":[{"code":"00145","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"PR ANESTH,IRIDECTOMY","code_information":[{"code":"00147","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"PR ANESTH,EYE EXAM","code_information":[{"code":"00148","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"PR ANESTH,NOSE,SINUS SURGERY","code_information":[{"code":"00160","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross 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SURGERY","code_information":[{"code":"00190","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"PR ANESTH,RADICAL FACIAL BONE SURGERY","code_information":[{"code":"00192","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"PR ANESTH,OPEN HEAD SURGERY","code_information":[{"code":"00210","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"PR ANESTH, INTRACRANIAL HEMATOMA EVACUATION","code_information":[{"code":"00211","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"PR ANESTH,SKULL SURG SUBDUR TAP","code_information":[{"code":"00212","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"PR ANESTH,SKULL SURG BURR HOLE","code_information":[{"code":"00214","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"PR ANESTH, CRANIOPLASTY","code_information":[{"code":"00215","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"PR ANESTH,HEAD VESSEL SURGERY","code_information":[{"code":"00216","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"PR ANESTH,SPECIAL HEAD SURGERY","code_information":[{"code":"00218","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"PR ANESTH,INTRACRAN PROC; CSF SHUNT 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RECONSTRUCTIVE","code_information":[{"code":"00402","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"PR ANESTH,SURG BREAST RAD MASTEC","code_information":[{"code":"00404","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"PR ANESTH,SURG BREAST RAD MAST W NODE","code_information":[{"code":"00406","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.53,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"PR ANESTH,CORRECT HEART 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Breast W/O Contrast Bilateral","code_information":[{"code":"2432517","type":"CDM"},{"code":"610","type":"RC"},{"code":"77047","type":"HCPCS"}],"standard_charges":[{"gross_charge":3896.0,"discounted_cash":2064.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16"},{"gross_charge":4583.0,"discounted_cash":2428.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"Hchrg Mammography Diagnostic Cad Unilateral","code_information":[{"code":"2432840","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":193.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16"},{"gross_charge":429.0,"discounted_cash":227.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"Hchrg Mammography Diagnostic Cad Bilateral","code_information":[{"code":"2432841","type":"CDM"},{"code":"401","type":"RC"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"discounted_cash":239.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16"},{"gross_charge":531.0,"discounted_cash":281.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"Hchrg Mammography Screening 2 View Cad Bilateral","code_information":[{"code":"2432842","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":181.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16"},{"gross_charge":403.0,"discounted_cash":213.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"Hchrg Hawkins-Akins 18G Needle","code_information":[{"code":"2432865","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":144.54,"discounted_cash":76.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"FLEXORPLASTY,ELBOW","code_information":[{"code":"24330","type":"CDM"}],"standard_charges":[{"gross_charge":1886.0,"discounted_cash":999.58,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"Hchrg Prostate Bx,Needle/Punch,Single Or Mu","code_information":[{"code":"2433000","type":"CDM"},{"code":"360","type":"RC"},{"code":"55700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2610.0,"discounted_cash":1383.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"FLEXORPLASTY,ELBOW,EXTENSOR ADVANCMT","code_information":[{"code":"24331","type":"CDM"}],"standard_charges":[{"gross_charge":2057.0,"discounted_cash":1090.21,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"TENOLYSIS, TRICEPS","code_information":[{"code":"24332","type":"CDM"}],"standard_charges":[{"gross_charge":1629.0,"discounted_cash":863.37,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"Hchrg Mri Orbit/Face/Neck W/Contrast","code_information":[{"code":"2433800","type":"CDM"},{"code":"610","type":"RC"},{"code":"70542","type":"HCPCS"}],"standard_charges":[{"gross_charge":3358.0,"discounted_cash":1779.74,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":3950.0,"discounted_cash":2093.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Orbit/Face/Neck W/O Contrast","code_information":[{"code":"2433801","type":"CDM"},{"code":"610","type":"RC"},{"code":"70540","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":941.81,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":2090.0,"discounted_cash":1107.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra-Abdomen W/3D Rend","code_information":[{"code":"2433802","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8900","type":"HCPCS"}],"standard_charges":[{"gross_charge":2018.0,"discounted_cash":1069.54,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":2374.0,"discounted_cash":1258.22,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra-Pelvis W/3D Rend","code_information":[{"code":"2433803","type":"CDM"},{"code":"610","type":"RC"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":3579.0,"discounted_cash":1896.87,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":4210.0,"discounted_cash":2231.3,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra-Head W/3D Rend","code_information":[{"code":"2433804","type":"CDM"},{"code":"610","type":"RC"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":3693.0,"discounted_cash":1957.29,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":4345.0,"discounted_cash":2302.85,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra Neck W/O Contrast","code_information":[{"code":"2433805","type":"CDM"},{"code":"615","type":"RC"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":941.81,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":2090.0,"discounted_cash":1107.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra Neck W/Contrast","code_information":[{"code":"2433806","type":"CDM"},{"code":"615","type":"RC"},{"code":"70548","type":"HCPCS"}],"standard_charges":[{"gross_charge":2709.0,"discounted_cash":1435.77,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":3187.0,"discounted_cash":1689.11,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra Neck W/O And W/Contrast","code_information":[{"code":"2433807","type":"CDM"},{"code":"615","type":"RC"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":3693.0,"discounted_cash":1957.29,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":4345.0,"discounted_cash":2302.85,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra Brain W/3D Rendering","code_information":[{"code":"2433808","type":"CDM"},{"code":"615","type":"RC"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1088.62,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":2416.0,"discounted_cash":1280.48,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Brain W/O Contrast","code_information":[{"code":"2433810","type":"CDM"},{"code":"611","type":"RC"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2830.0,"discounted_cash":1499.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":3329.0,"discounted_cash":1764.37,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra Brain W/Contrast","code_information":[{"code":"2433811","type":"CDM"},{"code":"610","type":"RC"},{"code":"70545","type":"HCPCS"}],"standard_charges":[{"gross_charge":2964.0,"discounted_cash":1570.92,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":3487.0,"discounted_cash":1848.11,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra Brain W/O Contrast","code_information":[{"code":"2433812","type":"CDM"},{"code":"615","type":"RC"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1088.62,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":2416.0,"discounted_cash":1280.48,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Brain W/Contrast","code_information":[{"code":"2433814","type":"CDM"},{"code":"611","type":"RC"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3357.0,"discounted_cash":1779.21,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":3949.0,"discounted_cash":2092.97,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Chest/Hilum/Med W/O And W/Contras","code_information":[{"code":"2433817","type":"CDM"},{"code":"610","type":"RC"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3907.0,"discounted_cash":2070.71,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":4597.0,"discounted_cash":2436.41,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Chest/Hilum/Med W/Contrast","code_information":[{"code":"2433819","type":"CDM"},{"code":"610","type":"RC"},{"code":"71551","type":"HCPCS"}],"standard_charges":[{"gross_charge":3390.0,"discounted_cash":1796.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":3988.0,"discounted_cash":2113.64,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Cervical Spine W/O And W/Contrast","code_information":[{"code":"2433820","type":"CDM"},{"code":"612","type":"RC"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":4505.0,"discounted_cash":2387.65,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":5300.0,"discounted_cash":2809.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Cervical Spine W/O Contrast","code_information":[{"code":"2433821","type":"CDM"},{"code":"612","type":"RC"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":2209.0,"discounted_cash":1170.77,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":2599.0,"discounted_cash":1377.47,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Cervical Spine W/Contrast","code_information":[{"code":"2433823","type":"CDM"},{"code":"612","type":"RC"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":3358.0,"discounted_cash":1779.74,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":3950.0,"discounted_cash":2093.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra Abdomen W/O And W/Contrast","code_information":[{"code":"2433825","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8902","type":"HCPCS"}],"standard_charges":[{"gross_charge":3948.0,"discounted_cash":2092.44,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":4645.0,"discounted_cash":2461.85,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra Chest W/O And W/Contrast","code_information":[{"code":"2433827","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8911","type":"HCPCS"}],"standard_charges":[{"gross_charge":3948.0,"discounted_cash":2092.44,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":4645.0,"discounted_cash":2461.85,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Thoracic Spine W/Contrast","code_information":[{"code":"2433833","type":"CDM"},{"code":"612","type":"RC"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":3555.0,"discounted_cash":1884.15,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":4182.0,"discounted_cash":2216.46,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Joint Upper Extremity W/O And W/C","code_information":[{"code":"2433838","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":6042.0,"discounted_cash":3202.26,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":7108.0,"discounted_cash":3767.24,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Lumbar Spine W/O And W/Contrast","code_information":[{"code":"2433840","type":"CDM"},{"code":"612","type":"RC"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":3907.0,"discounted_cash":2070.71,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":4597.0,"discounted_cash":2436.41,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Lumbar Spine W/O Contrast","code_information":[{"code":"2433841","type":"CDM"},{"code":"612","type":"RC"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":2589.0,"discounted_cash":1372.17,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":3046.0,"discounted_cash":1614.38,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Lumbar Spine W/Contrast","code_information":[{"code":"2433842","type":"CDM"},{"code":"612","type":"RC"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":3555.0,"discounted_cash":1884.15,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":4182.0,"discounted_cash":2216.46,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Upper Extremity W And W/O Contras","code_information":[{"code":"2433843","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":4315.0,"discounted_cash":2286.95,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":5077.0,"discounted_cash":2690.81,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Upper Extremity W/O Contrast","code_information":[{"code":"2433844","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":2845.0,"discounted_cash":1507.85,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":3347.0,"discounted_cash":1773.91,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Upper Extremity W/Contrast","code_information":[{"code":"2433845","type":"CDM"},{"code":"610","type":"RC"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":3555.0,"discounted_cash":1884.15,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":4182.0,"discounted_cash":2216.46,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Joint Upper Extremity W/Contrast","code_information":[{"code":"2433847","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":3970.0,"discounted_cash":2104.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":4670.0,"discounted_cash":2475.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Lower Extremity W/O Contrast","code_information":[{"code":"2433848","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":2589.0,"discounted_cash":1372.17,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":3046.0,"discounted_cash":1614.38,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Lower Extremity W/Contrast","code_information":[{"code":"2433849","type":"CDM"},{"code":"610","type":"RC"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":3021.0,"discounted_cash":1601.13,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":3554.0,"discounted_cash":1883.62,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Lower Extremity W/O And W/Contras","code_information":[{"code":"2433851","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":3885.0,"discounted_cash":2059.05,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":4570.0,"discounted_cash":2422.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Joint Lower Extremity W/Contrast","code_information":[{"code":"2433853","type":"CDM"},{"code":"610","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":4315.0,"discounted_cash":2286.95,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":5077.0,"discounted_cash":2690.81,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Abdomen W/O Contrast","code_information":[{"code":"2433854","type":"CDM"},{"code":"610","type":"RC"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":2157.0,"discounted_cash":1143.21,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":2538.0,"discounted_cash":1345.14,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Joint Lower Extremity W/O And W/C","code_information":[{"code":"2433855","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":5523.0,"discounted_cash":2927.19,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":6498.0,"discounted_cash":3443.94,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra Abdomen W/Contrast","code_information":[{"code":"2433856","type":"CDM"},{"code":"618","type":"RC"},{"code":"C8900","type":"HCPCS"}],"standard_charges":[{"gross_charge":2018.0,"discounted_cash":1069.54,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":2374.0,"discounted_cash":1258.22,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Abdomen W/Contrast","code_information":[{"code":"2433857","type":"CDM"},{"code":"610","type":"RC"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":3625.0,"discounted_cash":1921.25,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":4265.0,"discounted_cash":2260.45,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Abdomen W/O And W/Contrast","code_information":[{"code":"2433859","type":"CDM"},{"code":"610","type":"RC"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":4315.0,"discounted_cash":2286.95,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":5077.0,"discounted_cash":2690.81,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra Chest W/Contrast","code_information":[{"code":"2433862","type":"CDM"},{"code":"618","type":"RC"},{"code":"C8909","type":"HCPCS"}],"standard_charges":[{"gross_charge":2018.0,"discounted_cash":1069.54,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":2374.0,"discounted_cash":1258.22,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra Pelvis W/O And W/Contrast","code_information":[{"code":"2433866","type":"CDM"},{"code":"610","type":"RC"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":5491.0,"discounted_cash":2910.23,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":6460.0,"discounted_cash":3423.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra Upper Extremity W/O And W/Contras","code_information":[{"code":"2433868","type":"CDM"},{"code":"610","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":2589.0,"discounted_cash":1372.17,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":3046.0,"discounted_cash":1614.38,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra Lower Extremity W/Contrast","code_information":[{"code":"2433869","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8912","type":"HCPCS"}],"standard_charges":[{"gross_charge":3748.0,"discounted_cash":1986.44,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":4409.0,"discounted_cash":2336.77,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra Lower Extremity W/O And W/Contras","code_information":[{"code":"2433870","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8914","type":"HCPCS"}],"standard_charges":[{"gross_charge":2667.0,"discounted_cash":1413.51,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":3138.0,"discounted_cash":1663.14,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mra Lower Extremity W/O Contrast","code_information":[{"code":"2433871","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8913","type":"HCPCS"}],"standard_charges":[{"gross_charge":1685.0,"discounted_cash":893.05,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":1982.0,"discounted_cash":1050.46,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Mri Breast Unilat W/O And W/Contrast","code_information":[{"code":"2433873","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8905","type":"HCPCS"}],"standard_charges":[{"gross_charge":3544.0,"discounted_cash":1878.32,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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TB24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"25257","type":"CDM"},{"code":"A9270","type":"HCPCS"},{"code":"0904-6322-06","type":"NDC"}],"standard_charges":[{"gross_charge":9.02,"discounted_cash":4.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UN"}]},{"description":"MANIPULATE WRIST W/ANESTHES","code_information":[{"code":"25259","type":"CDM"}],"standard_charges":[{"gross_charge":1132.0,"discounted_cash":599.96,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"REPR FOREARM TEND/MUSC,FLEX,PRIM,EA","code_information":[{"code":"25260","type":"CDM"}],"standard_charges":[{"gross_charge":1685.0,"discounted_cash":893.05,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"REPR FOREARM TEND/MUSC,FLEX,SECON,EA","code_information":[{"code":"25263","type":"CDM"}],"standard_charges":[{"gross_charge":1677.0,"discounted_cash":888.81,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"REPR FOREARM TEND/FLEX,SECOND,GRFT","code_information":[{"code":"25265","type":"CDM"}],"standard_charges":[{"gross_charge":1981.0,"discounted_cash":1049.93,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"REPR FOREARM TEND/MUSC,EXTEN,PRIM,EA","code_information":[{"code":"25270","type":"CDM"}],"standard_charges":[{"gross_charge":1316.0,"discounted_cash":697.48,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"Hchrg Dacrocystrogram Unilateral","code_information":[{"code":"2527005","type":"CDM"},{"code":"320","type":"RC"},{"code":"70170","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.0,"discounted_cash":353.51,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Injection-Dacrocystrogram","code_information":[{"code":"2527006","type":"CDM"},{"code":"360","type":"RC"},{"code":"68850","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":56.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"Hchrg Orthopantogram","code_information":[{"code":"2527020","type":"CDM"},{"code":"320","type":"RC"},{"code":"70355","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":152.64,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Sialogram Contract Study-Dw","code_information":[{"code":"2527088","type":"CDM"},{"code":"320","type":"RC"},{"code":"70390","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.0,"discounted_cash":323.3,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Injection-Sialogram","code_information":[{"code":"2527089","type":"CDM"},{"code":"360","type":"RC"},{"code":"42550","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":56.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"Hchrg Ercp-Dw","code_information":[{"code":"2527112","type":"CDM"},{"code":"320","type":"RC"},{"code":"74330","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":478.59,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":1063.0,"discounted_cash":563.39,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":612.0,"discounted_cash":324.36,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Esophagus-Dw","code_information":[{"code":"2527335","type":"CDM"},{"code":"320","type":"RC"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":341.32,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":757.0,"discounted_cash":401.21,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Upper Gi W/O Kub - Dr","code_information":[{"code":"2527336","type":"CDM"},{"code":"320","type":"RC"},{"code":"74240","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":341.32,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Enteroclysis Sb Study-Dw","code_information":[{"code":"2527340","type":"CDM"},{"code":"320","type":"RC"},{"code":"74251","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":279.31,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":621.0,"discounted_cash":329.13,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Small Bowel Study-Dw","code_information":[{"code":"2527341","type":"CDM"},{"code":"320","type":"RC"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":193.98,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":430.0,"discounted_cash":227.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Upper Gi W/Air W/O Kub-Dr","code_information":[{"code":"2527343","type":"CDM"},{"code":"320","type":"RC"},{"code":"74246","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":341.32,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":757.0,"discounted_cash":401.21,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Lower Gi Colon-Dw","code_information":[{"code":"2527344","type":"CDM"},{"code":"320","type":"RC"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":341.32,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":757.0,"discounted_cash":401.21,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Lower Gi/Colon W/Air Cont-Dw","code_information":[{"code":"2527345","type":"CDM"},{"code":"320","type":"RC"},{"code":"74280","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":341.32,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":757.0,"discounted_cash":401.21,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Cholecystogram-Oral Contrast","code_information":[{"code":"2527348","type":"CDM"},{"code":"320","type":"RC"},{"code":"74290","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":193.98,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":430.0,"discounted_cash":227.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Uro Iv W/O Tomography-Dw","code_information":[{"code":"2527363","type":"CDM"},{"code":"320","type":"RC"},{"code":"74410","type":"HCPCS"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":605.79,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":1345.0,"discounted_cash":712.85,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Uro Iv W/Nephrotomograph-Dw","code_information":[{"code":"2527364","type":"CDM"},{"code":"320","type":"RC"},{"code":"74415","type":"HCPCS"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":605.79,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":1345.0,"discounted_cash":712.85,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Urography Retrograde-Dw","code_information":[{"code":"2527365","type":"CDM"},{"code":"320","type":"RC"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2067.0,"discounted_cash":1095.51,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":2432.0,"discounted_cash":1288.96,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Cystogram","code_information":[{"code":"2527368","type":"CDM"},{"code":"320","type":"RC"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":379.48,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":842.0,"discounted_cash":446.26,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Urethrocystogram-Dw","code_information":[{"code":"2527371","type":"CDM"},{"code":"320","type":"RC"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":557.03,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":1237.0,"discounted_cash":655.61,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Cystogram-Voiding-Dw","code_information":[{"code":"2527372","type":"CDM"},{"code":"320","type":"RC"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":557.03,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"},{"gross_charge":1237.0,"discounted_cash":655.61,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Injection Procedure-Cystogram","code_information":[{"code":"2527374","type":"CDM"},{"code":"320","type":"RC"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":104.41,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Hchrg Injection Procedure-Urethrocystography","code_information":[{"code":"2527375","type":"CDM"},{"code":"360","type":"RC"},{"code":"51610","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":168.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16"},{"gross_charge":374.0,"discounted_cash":198.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"Hchrg Hysterosalpingogram-Dw","code_information":[{"code":"2527394","type":"CDM"},{"code":"320","type":"RC"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":557.03,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16 | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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