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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 BRAIN W/CONTRAST","code_information":[{"code":"2433814","type":"CDM"},{"code":"0611","type":"RC"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3695.0,"discounted_cash":1958.35,"setting":"outpatient","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":3695.0,"discounted_cash":1958.35,"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":"0610","type":"RC"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":4469.0,"discounted_cash":2368.57,"setting":"outpatient","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":4469.0,"discounted_cash":2368.57,"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":"0610","type":"RC"},{"code":"71551","type":"HCPCS"}],"standard_charges":[{"gross_charge":3877.0,"discounted_cash":2054.81,"setting":"outpatient","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":3877.0,"discounted_cash":2054.81,"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 CERVICAL SPINE W/O AND W/CONTRAST","code_information":[{"code":"2433820","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":4960.0,"discounted_cash":2628.8,"setting":"outpatient","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":4960.0,"discounted_cash":2628.8,"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 MRI CERVICAL SPINE W/O CONTRAST","code_information":[{"code":"2433821","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":2432.0,"discounted_cash":1288.96,"setting":"outpatient","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 MRI CERVICAL SPINE W/CONTRAST","code_information":[{"code":"2433823","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":3696.0,"discounted_cash":1958.88,"setting":"outpatient","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":3696.0,"discounted_cash":1958.88,"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":"0610","type":"RC"},{"code":"C8902","type":"HCPCS"}],"standard_charges":[{"gross_charge":4516.0,"discounted_cash":2393.48,"setting":"outpatient","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":4516.0,"discounted_cash":2393.48,"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 MRA CHEST W/O AND W/CONTRAST","code_information":[{"code":"2433827","type":"CDM"},{"code":"0610","type":"RC"},{"code":"C8911","type":"HCPCS"}],"standard_charges":[{"gross_charge":4516.0,"discounted_cash":2393.48,"setting":"outpatient","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":4516.0,"discounted_cash":2393.48,"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 THORACIC SPINE W/CONTRAST","code_information":[{"code":"2433833","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":4066.0,"discounted_cash":2154.98,"setting":"outpatient","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":4066.0,"discounted_cash":2154.98,"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":"0610","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":6910.0,"discounted_cash":3662.3,"setting":"outpatient","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":6910.0,"discounted_cash":3662.3,"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 MRI LUMBAR SPINE W/O AND W/CONTRAST","code_information":[{"code":"2433840","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":4469.0,"discounted_cash":2368.57,"setting":"outpatient","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":4469.0,"discounted_cash":2368.57,"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":"0612","type":"RC"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":2961.0,"discounted_cash":1569.33,"setting":"outpatient","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":2961.0,"discounted_cash":1569.33,"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":"0612","type":"RC"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":4066.0,"discounted_cash":2154.98,"setting":"outpatient","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":4066.0,"discounted_cash":2154.98,"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":"0610","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":4936.0,"discounted_cash":2616.08,"setting":"outpatient","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":4936.0,"discounted_cash":2616.08,"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":"0610","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":3254.0,"discounted_cash":1724.62,"setting":"outpatient","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":3254.0,"discounted_cash":1724.62,"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 UPPER EXTREMITY W/CONTRAST","code_information":[{"code":"2433845","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":4066.0,"discounted_cash":2154.98,"setting":"outpatient","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":4066.0,"discounted_cash":2154.98,"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":"0610","type":"RC"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":4540.0,"discounted_cash":2406.2,"setting":"outpatient","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":4540.0,"discounted_cash":2406.2,"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":"0610","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":2961.0,"discounted_cash":1569.33,"setting":"outpatient","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":2961.0,"discounted_cash":1569.33,"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":"0610","type":"RC"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":3455.0,"discounted_cash":1831.15,"setting":"outpatient","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":3455.0,"discounted_cash":1831.15,"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":"0610","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":4443.0,"discounted_cash":2354.79,"setting":"outpatient","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":4443.0,"discounted_cash":2354.79,"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":"0610","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":4936.0,"discounted_cash":2616.08,"setting":"outpatient","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":4936.0,"discounted_cash":2616.08,"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":"0610","type":"RC"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":2467.0,"discounted_cash":1307.51,"setting":"outpatient","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":2467.0,"discounted_cash":1307.51,"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":"0610","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":6317.0,"discounted_cash":3348.01,"setting":"outpatient","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":6317.0,"discounted_cash":3348.01,"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":"0618","type":"RC"},{"code":"C8900","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1223.24,"setting":"outpatient","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":2308.0,"discounted_cash":1223.24,"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 ABDOMEN W/CONTRAST","code_information":[{"code":"2433857","type":"CDM"},{"code":"0610","type":"RC"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":4146.0,"discounted_cash":2197.38,"setting":"outpatient","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":4146.0,"discounted_cash":2197.38,"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 ABDOMEN W/O AND W/CONTRAST","code_information":[{"code":"2433859","type":"CDM"},{"code":"0610","type":"RC"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":4936.0,"discounted_cash":2616.08,"setting":"outpatient","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":4936.0,"discounted_cash":2616.08,"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":"0618","type":"RC"},{"code":"C8909","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1223.24,"setting":"outpatient","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":2308.0,"discounted_cash":1223.24,"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 MRA PELVIS W/O AND W/CONTRAST","code_information":[{"code":"2433866","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":4093.0,"discounted_cash":2169.29,"setting":"outpatient","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":4093.0,"discounted_cash":2169.29,"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":"0610","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":2961.0,"discounted_cash":1569.33,"setting":"outpatient","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":2961.0,"discounted_cash":1569.33,"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":"0610","type":"RC"},{"code":"C8912","type":"HCPCS"}],"standard_charges":[{"gross_charge":3051.0,"discounted_cash":1617.03,"setting":"outpatient","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":3051.0,"discounted_cash":1617.03,"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":"0610","type":"RC"},{"code":"C8914","type":"HCPCS"}],"standard_charges":[{"gross_charge":4286.0,"discounted_cash":2271.58,"setting":"outpatient","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":4286.0,"discounted_cash":2271.58,"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":"0610","type":"RC"},{"code":"C8913","type":"HCPCS"}],"standard_charges":[{"gross_charge":1927.0,"discounted_cash":1021.31,"setting":"outpatient","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":1927.0,"discounted_cash":1021.31,"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":"0610","type":"RC"},{"code":"C8905","type":"HCPCS"}],"standard_charges":[{"gross_charge":3544.0,"discounted_cash":1878.32,"setting":"outpatient","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":3544.0,"discounted_cash":1878.32,"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 BILAT W/O AND W/CONTRAST","code_information":[{"code":"2433875","type":"CDM"},{"code":"0610","type":"RC"},{"code":"C8908","type":"HCPCS"}],"standard_charges":[{"gross_charge":3642.0,"discounted_cash":1930.26,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16"},{"gross_charge":3642.0,"discounted_cash":1930.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG MRI PELVIS W/O AND W/CONTRAST","code_information":[{"code":"2433877","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":4516.0,"discounted_cash":2393.48,"setting":"outpatient","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":4516.0,"discounted_cash":2393.48,"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 PELVIS W/O CONTRAST","code_information":[{"code":"2433878","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":2961.0,"discounted_cash":1569.33,"setting":"outpatient","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":2961.0,"discounted_cash":1569.33,"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 MAMM-BREAST WIRE","code_information":[{"code":"2433891","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":57.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG MAMM-VACUUM CANISTER","code_information":[{"code":"2433893","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":59.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG WIRE, 80CM EXTRA STIFF AMPLATZ","code_information":[{"code":"2433895","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":91.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG DRAIN, 8FR FLEXI-FIRM PIGTAIL","code_information":[{"code":"2433896","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":201.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG NEEDLE, 21 GAUGE ACCUSTICK","code_information":[{"code":"2433897","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":161.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG MRI CARDIAC FOR MORPHOLOGY W/O CONTRA","code_information":[{"code":"2433900","type":"CDM"},{"code":"0610","type":"RC"},{"code":"75557","type":"HCPCS"}],"standard_charges":[{"gross_charge":3198.0,"discounted_cash":1694.94,"setting":"outpatient","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":3198.0,"discounted_cash":1694.94,"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 MRI CARDIAC VELOCITY FLOW","code_information":[{"code":"2433901","type":"CDM"},{"code":"0610","type":"RC"},{"code":"75565","type":"HCPCS"}],"standard_charges":[{"gross_charge":3948.0,"discounted_cash":2092.44,"setting":"outpatient","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":3948.0,"discounted_cash":2092.44,"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 CARDIAC STRESS IMG W/O CONTRAST","code_information":[{"code":"2433902","type":"CDM"},{"code":"0610","type":"RC"},{"code":"75559","type":"HCPCS"}],"standard_charges":[{"gross_charge":3314.0,"discounted_cash":1756.42,"setting":"outpatient","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":3314.0,"discounted_cash":1756.42,"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 CARDIAC VELOCITY FLOW STRESS","code_information":[{"code":"2433903","type":"CDM"},{"code":"0610","type":"RC"},{"code":"75565","type":"HCPCS"}],"standard_charges":[{"gross_charge":3948.0,"discounted_cash":2092.44,"setting":"outpatient","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":3948.0,"discounted_cash":2092.44,"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 CARDIAC FOR MORPHOLOGY W/CONTRAST","code_information":[{"code":"2433904","type":"CDM"},{"code":"0610","type":"RC"},{"code":"75561","type":"HCPCS"}],"standard_charges":[{"gross_charge":3787.0,"discounted_cash":2007.11,"setting":"outpatient","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":3787.0,"discounted_cash":2007.11,"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 MRI CARDIAC VELOCITY FLOW W/CONTRAST","code_information":[{"code":"2433905","type":"CDM"},{"code":"0610","type":"RC"},{"code":"75565","type":"HCPCS"}],"standard_charges":[{"gross_charge":3948.0,"discounted_cash":2092.44,"setting":"outpatient","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":3948.0,"discounted_cash":2092.44,"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 CARDIAC STRESS IMG W/CONTRAST","code_information":[{"code":"2433906","type":"CDM"},{"code":"0610","type":"RC"},{"code":"75563","type":"HCPCS"}],"standard_charges":[{"gross_charge":5122.0,"discounted_cash":2714.66,"setting":"outpatient","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":5122.0,"discounted_cash":2714.66,"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 CARDIAC VELOCITY FLOW STRESS W/CO","code_information":[{"code":"2433907","type":"CDM"},{"code":"0610","type":"RC"},{"code":"75565","type":"HCPCS"}],"standard_charges":[{"gross_charge":3948.0,"discounted_cash":2092.44,"setting":"outpatient","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":3948.0,"discounted_cash":2092.44,"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":"REPAIR OF BICEPS TENDON AT ELBOW","code_information":[{"code":"24340","type":"CDM"}],"standard_charges":[{"gross_charge":1599.0,"discounted_cash":847.47,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"24341","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"63739-196-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":5.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"24341","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"57237-314-31","type":"NDC"}],"standard_charges":[{"gross_charge":11.53,"discounted_cash":6.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"24341","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"24385-608-40","type":"NDC"}],"standard_charges":[{"gross_charge":8.59,"discounted_cash":4.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5ML PO 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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 URO IV W/O TOMOGRAPHY-DW","code_information":[{"code":"2527363","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74410","type":"HCPCS"}],"standard_charges":[{"gross_charge":1284.0,"discounted_cash":680.52,"setting":"outpatient","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":1284.0,"discounted_cash":680.52,"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":"0320","type":"RC"},{"code":"74415","type":"HCPCS"}],"standard_charges":[{"gross_charge":1284.0,"discounted_cash":680.52,"setting":"outpatient","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":1284.0,"discounted_cash":680.52,"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":"0320","type":"RC"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2322.0,"discounted_cash":1230.66,"setting":"outpatient","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":2322.0,"discounted_cash":1230.66,"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":"0320","type":"RC"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.0,"discounted_cash":426.12,"setting":"outpatient","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":804.0,"discounted_cash":426.12,"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":"0320","type":"RC"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":625.93,"setting":"outpatient","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":1181.0,"discounted_cash":625.93,"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":"0320","type":"RC"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":625.93,"setting":"outpatient","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":1181.0,"discounted_cash":625.93,"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":"0320","type":"RC"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":115.01,"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":"0360","type":"RC"},{"code":"51610","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":217.83,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16"},{"gross_charge":411.0,"discounted_cash":217.83,"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":"0320","type":"RC"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":625.93,"setting":"outpatient","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":1181.0,"discounted_cash":625.93,"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":"REPR FOREARM TEND/EXT,SECOND,GRAFT,EA","code_information":[{"code":"25274","type":"CDM"}],"standard_charges":[{"gross_charge":1761.0,"discounted_cash":933.33,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: professional"}]},{"description":"HCHRG TOMOGRAPHY 1 PLANE-DW","code_information":[{"code":"2527400","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76100","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":309.52,"setting":"outpatient","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":584.0,"discounted_cash":309.52,"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 DISCOGRAM-CERVICAL/THORACIC","code_information":[{"code":"2527418","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72285","type":"HCPCS"}],"standard_charges":[{"gross_charge":6869.0,"discounted_cash":3640.57,"setting":"outpatient","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":6869.0,"discounted_cash":3640.57,"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 DISCOGRAM-LUMBAR-DW","code_information":[{"code":"2527419","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72295","type":"HCPCS"}],"standard_charges":[{"gross_charge":6869.0,"discounted_cash":3640.57,"setting":"outpatient","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":6869.0,"discounted_cash":3640.57,"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 ARTHROGRAM SHOULDER-DW","code_information":[{"code":"2527424","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":412.34,"setting":"outpatient","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":778.0,"discounted_cash":412.34,"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 ARTHROGRAM ELBOW-DW","code_information":[{"code":"2527425","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73085","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":436.72,"setting":"outpatient","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":824.0,"discounted_cash":436.72,"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 ARTHROGRAM WRIST-DW","code_information":[{"code":"2527426","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73115","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":296.8,"setting":"outpatient","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":560.0,"discounted_cash":296.8,"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 ARTHROGRAM HIP-DW","code_information":[{"code":"2527427","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1185.0,"discounted_cash":628.05,"setting":"outpatient","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":1185.0,"discounted_cash":628.05,"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 ARTHROGRAM KNEE-DW","code_information":[{"code":"2527428","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1055.0,"discounted_cash":559.15,"setting":"outpatient","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":1055.0,"discounted_cash":559.15,"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 ARTHROGRAM ANKLE-DW","code_information":[{"code":"2527429","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":304.75,"setting":"outpatient","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":575.0,"discounted_cash":304.75,"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 ARTHROGRAM TMJ-DW","code_information":[{"code":"2527430","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70332","type":"HCPCS"}],"standard_charges":[{"gross_charge":866.0,"discounted_cash":458.98,"setting":"outpatient","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":866.0,"discounted_cash":458.98,"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 CONTRAST KNEE ARTHROGRAPHY CT MRI","code_information":[{"code":"2527431","type":"CDM"},{"code":"0360","type":"RC"},{"code":"27369","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":344.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG INJECTION PROCEDURE-TMJ ARTHROGRAM","code_information":[{"code":"2527432","type":"CDM"},{"code":"0360","type":"RC"},{"code":"21116","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":62.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG INJECTION PROCEDURE-SHOULDER ARTHROGRAM","code_information":[{"code":"2527434","type":"CDM"},{"code":"0360","type":"RC"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":890.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16"},{"gross_charge":1680.0,"discounted_cash":890.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG INJECTION PROCEDURE-ELBOW ARTHROGRAM","code_information":[{"code":"2527436","type":"CDM"},{"code":"0360","type":"RC"},{"code":"24220","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":219.42,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16"},{"gross_charge":414.0,"discounted_cash":219.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG INJECTION PROCEDURE-WRIST ARTHROGRAM","code_information":[{"code":"2527438","type":"CDM"},{"code":"0360","type":"RC"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":327.54,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16"},{"gross_charge":618.0,"discounted_cash":327.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG INJECTION PROCEDURE-HIP ARTHROGRAM","code_information":[{"code":"2527451","type":"CDM"},{"code":"0360","type":"RC"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":882.0,"discounted_cash":467.46,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16"},{"gross_charge":882.0,"discounted_cash":467.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG INJECTION PROCEDURE-ANKLE ARTHROGRAM","code_information":[{"code":"2527455","type":"CDM"},{"code":"0360","type":"RC"},{"code":"27648","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":271.36,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OUTPT IMAGING FSC 16"},{"gross_charge":512.0,"discounted_cash":271.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG ARTHRO ASP/INJ SM JT/BURSA W/O US GUID","code_information":[{"code":"2527466","type":"CDM"},{"code":"0360","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.0,"discounted_cash":576.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG ARTHRO ASP/INJ INTERMED  JT/BURSA W/O US GUID","code_information":[{"code":"2527467","type":"CDM"},{"code":"0360","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1121.0,"discounted_cash":594.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG ARTHRO ASP/INJ MAJOR JT/BURSA W/O US GUID","code_information":[{"code":"2527468","type":"CDM"},{"code":"0360","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1302.0,"discounted_cash":690.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG PERCUTANEOUS DRAINAGE W/CATHETER AND FLUOROSCOPY","code_information":[{"code":"2527469","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.0,"discounted_cash":412.87,"setting":"outpatient","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":779.0,"discounted_cash":412.87,"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 ARTHRO ASP/INJ SM JT/BURSA W/US GUID W/PERM RECORD&REPORT","code_information":[{"code":"2527471","type":"CDM"},{"code":"0360","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1468.0,"discounted_cash":778.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG ARTHRO ASP/INJ INTERMED  JT/BURSA W/US GUID W/PERM RECORD&REPORT","code_information":[{"code":"2527472","type":"CDM"},{"code":"0360","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1649.0,"discounted_cash":873.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Salem & Default FSC 1"}]},{"description":"HCHRG ARTHRO ASP/INJ MAJOR JT/BURSA W/US GUID W/PERM 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