{"hospital_name":"University of California Davis Medical Center","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["University of California Davis Medical Center"],"hospital_address":["2315 Stockton Boulevard, Sacramento, CA 95817"],"license_information":{"license_number":"030000086","state":"CA"},"type_2_npi":["1710918545","1700804200"],"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":"Paul LePage"},"financial_aid_policy":["60% off of facility standard gross charges."],"modifier_information":[{"description":"New equipment","code":"NU","modifier_payer_information":[{"payer_name":"ADVENTIST","plan_name":"UCD HB ADVENTIST","description":"The modified price is presented in the standard charge value."},{"payer_name":"AETNA","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"APWU","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS COVERED CA","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS MARSHALL EMP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS UC CARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS UC SHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS GMC","plan_name":"UCD HB BLUE CROSS GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS SENIOR","plan_name":"UCD HB BLUE CROSS MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD CALPERS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD IFP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD SENIOR","plan_name":"UCD HB BLUE SHIELD MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"CARPENTERS H&W","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CEMENT MASONS TRUST FUND","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CHDP","plan_name":"UCD HB MEDI-CAL CCS","description":"The modified price is presented in the standard charge value."},{"payer_name":"CIGNA","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CIGNA","plan_name":"UCD HB FIRST HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"CORESOURCE","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DELTA","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"DEPARTMENT OF VETERANS AFFAIRS","plan_name":"UCD HB TRIWEST VA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DEPARTMENT OF VETERANS AFFAIRS","plan_name":"UCD HB VA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DIGNITY/CHW","plan_name":"UCD HB DIGNITY HEALTH HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"DIGNITY/CHW","plan_name":"UCD HB WHA HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"GEHA","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB ADVENTIST","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB FIRST HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB INTERPLAN","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB TETHYS","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHPP","plan_name":"UCD HB MEDI-CAL CCS","description":"The modified price is presented in the standard charge value."},{"payer_name":"GREAT WEST HEALTHCARE","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHCOMP","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET AMBETTER ENHANCED PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET SMARTCARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET GMC","plan_name":"UCD HB HEALTH NET GMC REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET SENIOR","plan_name":"UCD HB HEALTH NET MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"HOMETOWN HEALTH","plan_name":"UCD HB HOMETOWN HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"IRONWORKERS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"JOINT BENEFIT TRUST","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER","plan_name":"UCD HB KAISER HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER","plan_name":"UCD HB KAISER TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER GMC","plan_name":"UCD HB KAISER HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER SENIOR ADVANTAGE","plan_name":"UCD HB KAISER MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER SENIOR ADVANTAGE","plan_name":"UCD HB KAISER TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"LABORERS HEALTH AND WELFARE","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"MAILHANDLERS","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"MOLINA GMC","plan_name":"UCD HB MOLINA GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"NALC","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"NORTHBAY HEALTHCARE","plan_name":"UCD HB NORTHBAY","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPERATING ENGRS HEALTH WELFARE","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH","plan_name":"UCD HB OPTUM COMM TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH MEDICARE RISK","plan_name":"UCD HB OPTUM MED ADV TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"PARTNERSHIP HEALTHPLAN GMC","plan_name":"UCD HB PARTNERSHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"PARTNERSHIP HEALTHPLAN/CCS","plan_name":"UCD HB PARTNERSHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"PIPE TRADES","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"SAN JOAQUIN HEALTH PLAN GMC","plan_name":"UCD HB OPTUM COMM TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"SAN JOAQUIN HEALTH PLAN GMC","plan_name":"UCD HB SAN JOAQUIN HP GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"SHEET METAL WORKERS UNION(SMW)","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"SIERRA PACIFIC INDUSTRIES","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"SUREST","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"SUREST","plan_name":"UCD HB UHC SELECT & SELECT PLUS","description":"The modified price is presented in the standard charge value."},{"payer_name":"TRICARE","plan_name":"UCD HB TRICARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"UFCW","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC HMO ASSIGNED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC SELECT & SELECT PLUS","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE MEDICARE","plan_name":"UCD HB UHC MED ADV PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE WEST","plan_name":"UCD HB UHC HMO REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED MEDICAL RESOURCE(UMR)","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"WESTERN GROWERS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."}]},{"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":"ADVENTIST","plan_name":"UCD HB ADVENTIST","description":"The modified price is presented in the standard charge value."},{"payer_name":"AETNA","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"APWU","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS COVERED CA","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS MARSHALL EMP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS UC CARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS UC SHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS GMC","plan_name":"UCD HB BLUE CROSS GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS SENIOR","plan_name":"UCD HB BLUE CROSS MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD CALPERS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD IFP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD SENIOR","plan_name":"UCD HB BLUE SHIELD MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"CARPENTERS H&W","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CEMENT MASONS TRUST FUND","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CHDP","plan_name":"UCD HB MEDI-CAL CCS","description":"The modified price is presented in the standard charge value."},{"payer_name":"CIGNA","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CIGNA","plan_name":"UCD HB FIRST HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"CORESOURCE","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DELTA","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"DEPARTMENT OF VETERANS AFFAIRS","plan_name":"UCD HB TRIWEST VA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DEPARTMENT OF VETERANS AFFAIRS","plan_name":"UCD HB VA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DIGNITY/CHW","plan_name":"UCD HB DIGNITY HEALTH HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"DIGNITY/CHW","plan_name":"UCD HB WHA HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"GEHA","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB ADVENTIST","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB FIRST HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB INTERPLAN","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB TETHYS","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHPP","plan_name":"UCD HB MEDI-CAL CCS","description":"The modified price is presented in the standard charge value."},{"payer_name":"GREAT WEST HEALTHCARE","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHCOMP","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET AMBETTER ENHANCED PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET SMARTCARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET GMC","plan_name":"UCD HB HEALTH NET GMC REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET SENIOR","plan_name":"UCD HB HEALTH NET MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"HOMETOWN HEALTH","plan_name":"UCD HB HOMETOWN HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"IRONWORKERS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"JOINT BENEFIT TRUST","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER","plan_name":"UCD HB KAISER HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER","plan_name":"UCD HB KAISER TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER GMC","plan_name":"UCD HB KAISER HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER SENIOR ADVANTAGE","plan_name":"UCD HB KAISER MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER SENIOR ADVANTAGE","plan_name":"UCD HB KAISER TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"LABORERS HEALTH AND WELFARE","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"MAILHANDLERS","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"MOLINA GMC","plan_name":"UCD HB MOLINA GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"NALC","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"NORTHBAY HEALTHCARE","plan_name":"UCD HB NORTHBAY","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPERATING ENGRS HEALTH WELFARE","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH","plan_name":"UCD HB OPTUM COMM TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH MEDICARE RISK","plan_name":"UCD HB OPTUM MED ADV TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"PARTNERSHIP HEALTHPLAN GMC","plan_name":"UCD HB PARTNERSHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"PARTNERSHIP HEALTHPLAN/CCS","plan_name":"UCD HB PARTNERSHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"PIPE TRADES","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"SAN JOAQUIN HEALTH PLAN GMC","plan_name":"UCD HB OPTUM COMM TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"SAN JOAQUIN HEALTH PLAN GMC","plan_name":"UCD HB SAN JOAQUIN HP GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"SHEET METAL WORKERS UNION(SMW)","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"SIERRA PACIFIC INDUSTRIES","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"SUREST","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"SUREST","plan_name":"UCD HB UHC SELECT & SELECT PLUS","description":"The modified price is presented in the standard charge value."},{"payer_name":"TRICARE","plan_name":"UCD HB TRICARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"UFCW","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC HMO ASSIGNED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC SELECT & SELECT PLUS","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE MEDICARE","plan_name":"UCD HB UHC MED ADV PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE WEST","plan_name":"UCD HB UHC HMO REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED MEDICAL RESOURCE(UMR)","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"WESTERN GROWERS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Clia waived test","code":"QW","modifier_payer_information":[{"payer_name":"ADVENTIST","plan_name":"UCD HB ADVENTIST","description":"The modified price is presented in the standard charge value."},{"payer_name":"AETNA","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"APWU","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS COVERED CA","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS MARSHALL EMP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS UC CARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS UC SHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS GMC","plan_name":"UCD HB BLUE CROSS GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS SENIOR","plan_name":"UCD HB BLUE CROSS MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD CALPERS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD IFP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD SENIOR","plan_name":"UCD HB BLUE SHIELD MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"CARPENTERS H&W","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CEMENT MASONS TRUST FUND","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CHDP","plan_name":"UCD HB MEDI-CAL CCS","description":"The modified price is presented in the standard charge value."},{"payer_name":"CIGNA","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CIGNA","plan_name":"UCD HB FIRST HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"CORESOURCE","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DELTA","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"DEPARTMENT OF VETERANS AFFAIRS","plan_name":"UCD HB TRIWEST VA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DEPARTMENT OF VETERANS AFFAIRS","plan_name":"UCD HB VA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DIGNITY/CHW","plan_name":"UCD HB DIGNITY HEALTH HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"DIGNITY/CHW","plan_name":"UCD HB WHA HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"GEHA","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB ADVENTIST","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB FIRST HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB INTERPLAN","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB TETHYS","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHPP","plan_name":"UCD HB MEDI-CAL CCS","description":"The modified price is presented in the standard charge value."},{"payer_name":"GREAT WEST HEALTHCARE","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHCOMP","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET AMBETTER ENHANCED PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET SMARTCARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET GMC","plan_name":"UCD HB HEALTH NET GMC REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET SENIOR","plan_name":"UCD HB HEALTH NET MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"HOMETOWN HEALTH","plan_name":"UCD HB HOMETOWN HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"IRONWORKERS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"JOINT BENEFIT TRUST","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER","plan_name":"UCD HB KAISER HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER","plan_name":"UCD HB KAISER TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER GMC","plan_name":"UCD HB KAISER HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER SENIOR ADVANTAGE","plan_name":"UCD HB KAISER MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER SENIOR ADVANTAGE","plan_name":"UCD HB KAISER TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"LABORERS HEALTH AND WELFARE","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"MAILHANDLERS","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"MOLINA GMC","plan_name":"UCD HB MOLINA GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"NALC","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"NORTHBAY HEALTHCARE","plan_name":"UCD HB NORTHBAY","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPERATING ENGRS HEALTH WELFARE","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH","plan_name":"UCD HB OPTUM COMM TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH MEDICARE RISK","plan_name":"UCD HB OPTUM MED ADV TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"PARTNERSHIP HEALTHPLAN GMC","plan_name":"UCD HB PARTNERSHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"PARTNERSHIP HEALTHPLAN/CCS","plan_name":"UCD HB PARTNERSHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"PIPE TRADES","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"SAN JOAQUIN HEALTH PLAN GMC","plan_name":"UCD HB OPTUM COMM TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"SAN JOAQUIN HEALTH PLAN GMC","plan_name":"UCD HB SAN JOAQUIN HP GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"SHEET METAL WORKERS UNION(SMW)","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"SIERRA PACIFIC INDUSTRIES","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"SUREST","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"SUREST","plan_name":"UCD HB UHC SELECT & SELECT PLUS","description":"The modified price is presented in the standard charge value."},{"payer_name":"TRICARE","plan_name":"UCD HB TRICARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"UFCW","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC HMO ASSIGNED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC SELECT & SELECT PLUS","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE MEDICARE","plan_name":"UCD HB UHC MED ADV PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE WEST","plan_name":"UCD HB UHC HMO REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED MEDICAL RESOURCE(UMR)","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"WESTERN GROWERS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Reference (Outside) Laboratory","code":"90","modifier_payer_information":[{"payer_name":"ADVENTIST","plan_name":"UCD HB ADVENTIST","description":"The modified price is presented in the standard charge value."},{"payer_name":"AETNA","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"APWU","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS COVERED CA","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS MARSHALL EMP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS UC CARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS UC SHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS GMC","plan_name":"UCD HB BLUE CROSS GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS SENIOR","plan_name":"UCD HB BLUE CROSS MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD CALPERS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD IFP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD SENIOR","plan_name":"UCD HB BLUE SHIELD MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"CARPENTERS H&W","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CEMENT MASONS TRUST FUND","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CHDP","plan_name":"UCD HB MEDI-CAL CCS","description":"The modified price is presented in the standard charge value."},{"payer_name":"CIGNA","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CIGNA","plan_name":"UCD HB FIRST HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"CORESOURCE","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DELTA","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"DEPARTMENT OF VETERANS AFFAIRS","plan_name":"UCD HB TRIWEST VA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DEPARTMENT OF VETERANS AFFAIRS","plan_name":"UCD HB VA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DIGNITY/CHW","plan_name":"UCD HB DIGNITY HEALTH HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"DIGNITY/CHW","plan_name":"UCD HB WHA HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"GEHA","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB ADVENTIST","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB FIRST HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB INTERPLAN","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB TETHYS","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHPP","plan_name":"UCD HB MEDI-CAL CCS","description":"The modified price is presented in the standard charge value."},{"payer_name":"GREAT WEST HEALTHCARE","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHCOMP","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET AMBETTER ENHANCED PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET SMARTCARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET GMC","plan_name":"UCD HB HEALTH NET GMC REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET SENIOR","plan_name":"UCD HB HEALTH NET MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"HOMETOWN HEALTH","plan_name":"UCD HB HOMETOWN HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"IRONWORKERS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"JOINT BENEFIT TRUST","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER","plan_name":"UCD HB KAISER HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER","plan_name":"UCD HB KAISER TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER GMC","plan_name":"UCD HB KAISER HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER SENIOR ADVANTAGE","plan_name":"UCD HB KAISER MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER SENIOR ADVANTAGE","plan_name":"UCD HB KAISER TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"LABORERS HEALTH AND WELFARE","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"MAILHANDLERS","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"MOLINA GMC","plan_name":"UCD HB MOLINA GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"NALC","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"NORTHBAY HEALTHCARE","plan_name":"UCD HB NORTHBAY","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPERATING ENGRS HEALTH WELFARE","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH","plan_name":"UCD HB OPTUM COMM TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH MEDICARE RISK","plan_name":"UCD HB OPTUM MED ADV TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"PARTNERSHIP HEALTHPLAN GMC","plan_name":"UCD HB PARTNERSHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"PARTNERSHIP HEALTHPLAN/CCS","plan_name":"UCD HB PARTNERSHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"PIPE TRADES","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"SAN JOAQUIN HEALTH PLAN GMC","plan_name":"UCD HB OPTUM COMM TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"SAN JOAQUIN HEALTH PLAN GMC","plan_name":"UCD HB SAN JOAQUIN HP GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"SHEET METAL WORKERS UNION(SMW)","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"SIERRA PACIFIC INDUSTRIES","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"SUREST","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"SUREST","plan_name":"UCD HB UHC SELECT & SELECT PLUS","description":"The modified price is presented in the standard charge value."},{"payer_name":"TRICARE","plan_name":"UCD HB TRICARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"UFCW","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC HMO ASSIGNED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC SELECT & SELECT PLUS","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE MEDICARE","plan_name":"UCD HB UHC MED ADV PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE WEST","plan_name":"UCD HB UHC HMO REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED MEDICAL RESOURCE(UMR)","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"WESTERN GROWERS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Modifier description not available","code":"C9","modifier_payer_information":[{"payer_name":"ADVENTIST","plan_name":"UCD HB ADVENTIST","description":"The modified price is presented in the standard charge value."},{"payer_name":"AETNA","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"APWU","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS COVERED CA","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS MARSHALL EMP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS UC CARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS UC SHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS GMC","plan_name":"UCD HB BLUE CROSS GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS SENIOR","plan_name":"UCD HB BLUE CROSS MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD CALPERS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD IFP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD SENIOR","plan_name":"UCD HB BLUE SHIELD MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"CARPENTERS H&W","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CEMENT MASONS TRUST FUND","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CHDP","plan_name":"UCD HB MEDI-CAL CCS","description":"The modified price is presented in the standard charge value."},{"payer_name":"CIGNA","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CIGNA","plan_name":"UCD HB FIRST HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"CORESOURCE","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DELTA","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"DEPARTMENT OF VETERANS AFFAIRS","plan_name":"UCD HB TRIWEST VA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DEPARTMENT OF VETERANS AFFAIRS","plan_name":"UCD HB VA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DIGNITY/CHW","plan_name":"UCD HB DIGNITY HEALTH HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"DIGNITY/CHW","plan_name":"UCD HB WHA HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"GEHA","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB ADVENTIST","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB FIRST HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB INTERPLAN","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB TETHYS","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHPP","plan_name":"UCD HB MEDI-CAL CCS","description":"The modified price is presented in the standard charge value."},{"payer_name":"GREAT WEST HEALTHCARE","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHCOMP","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET AMBETTER ENHANCED PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET SMARTCARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET GMC","plan_name":"UCD HB HEALTH NET GMC REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET SENIOR","plan_name":"UCD HB HEALTH NET MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"HOMETOWN HEALTH","plan_name":"UCD HB HOMETOWN HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"IRONWORKERS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"JOINT BENEFIT TRUST","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER","plan_name":"UCD HB KAISER HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER","plan_name":"UCD HB KAISER TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER GMC","plan_name":"UCD HB KAISER HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER SENIOR ADVANTAGE","plan_name":"UCD HB KAISER MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER SENIOR ADVANTAGE","plan_name":"UCD HB KAISER TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"LABORERS HEALTH AND WELFARE","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"MAILHANDLERS","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"MOLINA GMC","plan_name":"UCD HB MOLINA GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"NALC","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"NORTHBAY HEALTHCARE","plan_name":"UCD HB NORTHBAY","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPERATING ENGRS HEALTH WELFARE","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH","plan_name":"UCD HB OPTUM COMM TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH MEDICARE RISK","plan_name":"UCD HB OPTUM MED ADV TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"PARTNERSHIP HEALTHPLAN GMC","plan_name":"UCD HB PARTNERSHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"PARTNERSHIP HEALTHPLAN/CCS","plan_name":"UCD HB PARTNERSHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"PIPE TRADES","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"SAN JOAQUIN HEALTH PLAN GMC","plan_name":"UCD HB OPTUM COMM TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"SAN JOAQUIN HEALTH PLAN GMC","plan_name":"UCD HB SAN JOAQUIN HP GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"SHEET METAL WORKERS UNION(SMW)","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"SIERRA PACIFIC INDUSTRIES","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"SUREST","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"SUREST","plan_name":"UCD HB UHC SELECT & SELECT PLUS","description":"The modified price is presented in the standard charge value."},{"payer_name":"TRICARE","plan_name":"UCD HB TRICARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"UFCW","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC HMO ASSIGNED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC SELECT & SELECT PLUS","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE MEDICARE","plan_name":"UCD HB UHC MED ADV PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE WEST","plan_name":"UCD HB UHC HMO REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED MEDICAL RESOURCE(UMR)","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"WESTERN GROWERS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"ADVENTIST","plan_name":"UCD HB ADVENTIST","description":"The modified price is presented in the standard charge value."},{"payer_name":"AETNA","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"APWU","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS COVERED CA","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS MARSHALL EMP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS UC CARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS","plan_name":"UCD HB BLUE CROSS UC SHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS GMC","plan_name":"UCD HB BLUE CROSS GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE CROSS SENIOR","plan_name":"UCD HB BLUE CROSS MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD CALPERS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD IFP","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"BLUE SHIELD SENIOR","plan_name":"UCD HB BLUE SHIELD MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"CARPENTERS H&W","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CEMENT MASONS TRUST FUND","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CHDP","plan_name":"UCD HB MEDI-CAL CCS","description":"The modified price is presented in the standard charge value."},{"payer_name":"CIGNA","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CIGNA","plan_name":"UCD HB FIRST HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"CORESOURCE","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DELTA","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"DEPARTMENT OF VETERANS AFFAIRS","plan_name":"UCD HB TRIWEST VA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DEPARTMENT OF VETERANS AFFAIRS","plan_name":"UCD HB VA","description":"The modified price is presented in the standard charge value."},{"payer_name":"DIGNITY/CHW","plan_name":"UCD HB DIGNITY HEALTH HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"DIGNITY/CHW","plan_name":"UCD HB WHA HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"GEHA","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB ADVENTIST","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB FIRST HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB INTERPLAN","description":"The modified price is presented in the standard charge value."},{"payer_name":"GENERIC","plan_name":"UCD HB TETHYS","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHPP","plan_name":"UCD HB MEDI-CAL CCS","description":"The modified price is presented in the standard charge value."},{"payer_name":"GREAT WEST HEALTHCARE","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHCOMP","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET AMBETTER ENHANCED PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET","plan_name":"UCD HB HEALTH NET SMARTCARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET GMC","plan_name":"UCD HB HEALTH NET GMC REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"HEALTHNET SENIOR","plan_name":"UCD HB HEALTH NET MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"HOMETOWN HEALTH","plan_name":"UCD HB HOMETOWN HEALTH","description":"The modified price is presented in the standard charge value."},{"payer_name":"IRONWORKERS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"JOINT BENEFIT TRUST","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER","plan_name":"UCD HB KAISER HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER","plan_name":"UCD HB KAISER TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER GMC","plan_name":"UCD HB KAISER HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER SENIOR ADVANTAGE","plan_name":"UCD HB KAISER MED ADV","description":"The modified price is presented in the standard charge value."},{"payer_name":"KAISER SENIOR ADVANTAGE","plan_name":"UCD HB KAISER TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"LABORERS HEALTH AND WELFARE","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"MAILHANDLERS","plan_name":"UCD HB AETNA","description":"The modified price is presented in the standard charge value."},{"payer_name":"MOLINA GMC","plan_name":"UCD HB MOLINA GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"NALC","plan_name":"UCD HB CIGNA PPO HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"NORTHBAY HEALTHCARE","plan_name":"UCD HB NORTHBAY","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPERATING ENGRS HEALTH WELFARE","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH","plan_name":"UCD HB OPTUM COMM TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OPTUMHEALTH MEDICARE RISK","plan_name":"UCD HB OPTUM MED ADV TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"PARTNERSHIP HEALTHPLAN GMC","plan_name":"UCD HB PARTNERSHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"PARTNERSHIP HEALTHPLAN/CCS","plan_name":"UCD HB PARTNERSHIP","description":"The modified price is presented in the standard charge value."},{"payer_name":"PIPE TRADES","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"SAN JOAQUIN HEALTH PLAN GMC","plan_name":"UCD HB OPTUM COMM TRANSPLANT","description":"The modified price is presented in the standard charge value."},{"payer_name":"SAN JOAQUIN HEALTH PLAN GMC","plan_name":"UCD HB SAN JOAQUIN HP GMC","description":"The modified price is presented in the standard charge value."},{"payer_name":"SHEET METAL WORKERS UNION(SMW)","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"SIERRA PACIFIC INDUSTRIES","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"SUREST","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"SUREST","plan_name":"UCD HB UHC SELECT & SELECT PLUS","description":"The modified price is presented in the standard charge value."},{"payer_name":"TRICARE","plan_name":"UCD HB TRICARE","description":"The modified price is presented in the standard charge value."},{"payer_name":"UFCW","plan_name":"UCD HB BLUE SHIELD REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC HMO ASSIGNED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE","plan_name":"UCD HB UHC SELECT & SELECT PLUS","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE MEDICARE","plan_name":"UCD HB UHC MED ADV PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED HEALTHCARE WEST","plan_name":"UCD HB UHC HMO REFERRED","description":"The modified price is presented in the standard charge value."},{"payer_name":"UNITED MEDICAL RESOURCE(UMR)","plan_name":"UCD HB UHC NON HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"WESTERN GROWERS","plan_name":"UCD HB BLUE CROSS PPO","description":"The modified price is presented in the standard charge value."}]}],"standard_charge_information":[{"description":"STUDY DRUG - CD19 CAR-T CELLS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3590","type":"HCPCS"},{"code":"99999-0068-54","type":"NDC"}],"standard_charges":[{"gross_charge":49313.0,"discounted_cash":19725.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"SERTRALINE 50 MG TABLET","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"50268-769-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":3.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 50 MG TABLET","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"50268-769-15","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"VALGANCICLOVIR 450 MG TABLET","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"50268-787-12","type":"NDC"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"}]},{"description":"VALACYCLOVIR 500 MG TABLET","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"50268-788-11","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VALACYCLOVIR 500 MG TABLET","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"50268-788-15","type":"NDC"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"URSODIOL 300 MG CAPSULE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"50268-797-15","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ZIPRASIDONE 40 MG CAPSULE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"50268-812-11","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ZIPRASIDONE 40 MG CAPSULE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"50268-812-12","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML SOLUTION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"5026818311","type":"NDC"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":42.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 334 MG"}]},{"description":"SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML SOLUTION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"5026818330","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 334 MG"}]},{"description":"FERROUS SULFATE 300 MG (60 MG IRON)/5 ML LIQUID","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"5026833611","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"FERROUS SULFATE 300 MG/5 ML (60 MG/5 ML ELEMENTAL IRON) LIQUID","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"5026833624","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":6.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"MELATONIN 3 MG TABLET","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"5026852411","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"TERAZOSIN 5 MG CAPSULE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"50268-766-15","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":5.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"THIAMINE 100 MG TABLET","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"5026885115","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"CYANOCOBALAMIN 500 MCG TABLET","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"5026885415","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":3.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"PYRIDOXINE 50 MG TABLET","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"5026885815","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ASCORBIC ACID 250 MG TABLET","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"5026886015","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"CHOLECALCIFEROL 10 MCG (400 UNIT) TABLET","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"5026886315","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MCG"}]},{"description":"CHOLECALCIFEROL 50 MCG (2,000 UNIT) TABLET","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"5026886515","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"CHOLECALCIFEROL 125 MCG (5,000 UNIT) TABLET","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"5026886615","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"}]},{"description":"PHENYLEPHRINE 0.25% NON-AEROSOL SPRAY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"5032300602","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PREDNISOLONE 15 MG/5 ML SOLUTION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"50383-042-48","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"}]},{"description":"LEVOFLOXACIN 250 MG/10 ML SOLUTION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"50383-286-16","type":"NDC"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":50.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"DOCUSATE 50 MG/5 ML LIQUID","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"50383-349-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ALBUTEROL 5 MG/ML (0.5%) SOLUTION FOR NEBULIZATION 20 ML BOTTLE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"50383-741-20","type":"NDC"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LIDOCAINE 2 % SOLUTION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"50383-775-04","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":6.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LIDOCAINE 2 % SOLUTION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"50383-775-17","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":6.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CYANOCOBALAMIN 100 MCG 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OINTMENT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"50268-568-15","type":"NDC"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":57.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"MIDODRINE 5 MG TABLET","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"50268-562-15","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MYCOPHENOLATE 250 MG 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SYRINGE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2777","type":"HCPCS"},{"code":"50242-096-06","type":"NDC"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"FARICIMAB 6 MG/0.05 ML SOLUTION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2777","type":"HCPCS"},{"code":"50242-096-86","type":"NDC"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":103.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"POLATUZUMAB VEDOTIN-PIIQ 30 MG RECONSTITUTE SOLUTION 1 EACH 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