{
    "Surg Hos @ Southwoods 2021": [
        {
            "Charge Code": "11000010",
            "Item/Package": "Item",
            "Description": "Private Room",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "110",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,633.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,143.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11000014",
            "Item/Package": "Item",
            "Description": "Outpatient Bed",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "160",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $631.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $441.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90078",
            "Item/Package": "Item",
            "Description": "BARIUM SULFATE 450 ML ORAL.SUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90188",
            "Item/Package": "Item",
            "Description": "DEXTROSE 5% IN WATER 100 ML IV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90429",
            "Item/Package": "Item",
            "Description": "LIDOCAINE 2% 20 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90816",
            "Item/Package": "Item",
            "Description": "PATIENT OWN MEDICATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90047",
            "Item/Package": "Item",
            "Description": "ASPIRIN 325 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.06 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90263",
            "Item/Package": "Item",
            "Description": "FERROUS SULFATE 325 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.06 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90049",
            "Item/Package": "Item",
            "Description": "ASPIRIN(ECOTRIN) 81 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90045",
            "Item/Package": "Item",
            "Description": "ASPIRIN (ECOTRIN) 325 MG TABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90697",
            "Item/Package": "Item",
            "Description": "THIAMINE(VIT B-1) 100 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90023",
            "Item/Package": "Item",
            "Description": "ALPRAZOLAM (XANAX) 0.25 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90645",
            "Item/Package": "Item",
            "Description": "SIMETHICONE(MYLICON) 80 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90050",
            "Item/Package": "Item",
            "Description": "ASPIRIN/ACETAMIN/CAFFEINE 250/",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.13 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90785",
            "Item/Package": "Item",
            "Description": "CALCIUM CARB TUMS 500MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90115",
            "Item/Package": "Item",
            "Description": "CAL CARBON/VITAMIN D3 5000U",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.15 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90330",
            "Item/Package": "Item",
            "Description": "HUMULIN (NOVOLIN) 70/30",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90358",
            "Item/Package": "Item",
            "Description": "IBUPROFEN 200 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90211",
            "Item/Package": "Item",
            "Description": "DIPHENHYDRAMINE  25 MG CAPSULE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90336",
            "Item/Package": "Item",
            "Description": "HYDROCHLOROTHIAZIDE 25 MG TABL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90113",
            "Item/Package": "Item",
            "Description": "CALCIUM CARBONATE (OYSTER SHEL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90091",
            "Item/Package": "Item",
            "Description": "BISACODYL 5 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90694",
            "Item/Package": "Item",
            "Description": "THERA M PLUS TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90218",
            "Item/Package": "Item",
            "Description": "DOCUSATE  100 MG CAPSULE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90695",
            "Item/Package": "Item",
            "Description": "THERA TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90005",
            "Item/Package": "Item",
            "Description": "ACETAMINOPHEN (TYLENOL) 325 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90048",
            "Item/Package": "Item",
            "Description": "ASPIRIN 81 MG TAB.CHEW",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $23.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90311",
            "Item/Package": "Item",
            "Description": "GLYBURIDE 2.5 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90742",
            "Item/Package": "Item",
            "Description": "VITAMIN E 400 UNIT CAPSULE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90044",
            "Item/Package": "Item",
            "Description": "ASCORBIC ACID 500 MG (VITAMIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $25.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90176",
            "Item/Package": "Item",
            "Description": "CYCLOBENZAPRINE (FLEXERIL) 10",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90641",
            "Item/Package": "Item",
            "Description": "SENOKOT 8.6 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90006",
            "Item/Package": "Item",
            "Description": "ACETAMINOPHEN (TYLENOL) 500 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90626",
            "Item/Package": "Item",
            "Description": "RAMIPRIL(ALTACE) 2.5 MG CAPSUL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90606",
            "Item/Package": "Item",
            "Description": "PROBIOTIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90847",
            "Item/Package": "Item",
            "Description": "CITALOPRAM(CELEXA) 10MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90827",
            "Item/Package": "Item",
            "Description": "BISOPOLOL FUM HCTZ 10MG/6.5MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90991",
            "Item/Package": "Item",
            "Description": "SODIUM BICARB 650MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90165",
            "Item/Package": "Item",
            "Description": "CLONAZEPAM(KLONOPIN) 1 MG TABL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90287",
            "Item/Package": "Item",
            "Description": "FUROSEMIDE(LASIX) 20 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90288",
            "Item/Package": "Item",
            "Description": "FUROSEMIDE(LASIX) 40 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90114",
            "Item/Package": "Item",
            "Description": "CALC CARBON/VITAMIN D3 2000U",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90857",
            "Item/Package": "Item",
            "Description": "DIAZEPAM VALIUM 2MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90024",
            "Item/Package": "Item",
            "Description": "ALPRAZOLAM (XANAX) 1 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90512",
            "Item/Package": "Item",
            "Description": "NEO/BACITRA/POLY(NEOSPORIN) PK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.40 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90709",
            "Item/Package": "Item",
            "Description": "TRAMADOL HCL 50 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.40 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90752",
            "Item/Package": "Item",
            "Description": "ZOLPIDEM(AMBEIN) 5 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.40 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90274",
            "Item/Package": "Item",
            "Description": "FLUOXETINE (PROZAC) 10 MG CAPS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90488",
            "Item/Package": "Item",
            "Description": "METOPROLOL TARTRATE (LOPRESSOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90590",
            "Item/Package": "Item",
            "Description": "POVIDONE-IODINE 1 GM OINT PKT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90144",
            "Item/Package": "Item",
            "Description": "CETIRIZINE(ZYRTEC) 10 MG TABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90157",
            "Item/Package": "Item",
            "Description": "CITALOPRAM(CELEXA)20 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90124",
            "Item/Package": "Item",
            "Description": "CARVEDILOL (COREG) 25 MG TABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90487",
            "Item/Package": "Item",
            "Description": "METOPROLOL TARTRATE (LOPRESSOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90193",
            "Item/Package": "Item",
            "Description": "DIAZEPAM 5 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.45 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90447",
            "Item/Package": "Item",
            "Description": "LISINOPRIL(PRINIVIL) 5 MG TABL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90459",
            "Item/Package": "Item",
            "Description": "MAGNESIUM OXIDE 400 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90372",
            "Item/Package": "Item",
            "Description": "OMNIPAQUE 240MG/ML 50ML BOTTLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90354",
            "Item/Package": "Item",
            "Description": "HYDROXYZINE PAMOATE (VISTARIL)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90469",
            "Item/Package": "Item",
            "Description": "METFORMIN (GLUCOPHAGE) 500 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90744",
            "Item/Package": "Item",
            "Description": "WARFARIN SODIUM 2 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90511",
            "Item/Package": "Item",
            "Description": "NAPROXEN(NAPROSYN)500 MG TABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90737",
            "Item/Package": "Item",
            "Description": "VERAPAMIL(CALAN SR) 120 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90220",
            "Item/Package": "Item",
            "Description": "DONEPEZIL 10 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90636",
            "Item/Package": "Item",
            "Description": "ROPINIROLE(REQUIP) 2 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90685",
            "Item/Package": "Item",
            "Description": "TANNIC ACID 500 GM POWDER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90867",
            "Item/Package": "Item",
            "Description": "CITRACAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90332",
            "Item/Package": "Item",
            "Description": "HYDRALAZINE 10 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90031",
            "Item/Package": "Item",
            "Description": "AMLODIPINE (NORVASC) 5 MG TABL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90526",
            "Item/Package": "Item",
            "Description": "NOVOLIN R 100 UNIT/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90738",
            "Item/Package": "Item",
            "Description": "VERAPAMIL(CALAN SR) 240 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90052",
            "Item/Package": "Item",
            "Description": "ATENOLOL (TENORMIN) 50 MG TABL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90841",
            "Item/Package": "Item",
            "Description": "CEPACOL SUGAR-FREE LOZENGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90899",
            "Item/Package": "Item",
            "Description": "DIPHENHYDRAMINE HCL 30GM CREAM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90333",
            "Item/Package": "Item",
            "Description": "HYDRALAZINE HCL 25 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90291",
            "Item/Package": "Item",
            "Description": "GABAPENTIN(NEURONTIN)100 MG CA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90649",
            "Item/Package": "Item",
            "Description": "SIMVASTATIN(ZOCOR) 40 MG TABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90166",
            "Item/Package": "Item",
            "Description": "CLONIDINE(CATAPRES)0.1 MG TABL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90821",
            "Item/Package": "Item",
            "Description": "METFORMIN HCL ER TAB 500MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90209",
            "Item/Package": "Item",
            "Description": "DILTIAZEM 30 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90446",
            "Item/Package": "Item",
            "Description": "LISINOPRIL(PRINIVIL) 20 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90640",
            "Item/Package": "Item",
            "Description": "SENNA-S(PERI-COLACE) 8.6 MG/50",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90672",
            "Item/Package": "Item",
            "Description": "SODIUM CHLORIDE FOR INHALATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90064",
            "Item/Package": "Item",
            "Description": "BACITRACIN ZINC OINT .9GM PACK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.71 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90359",
            "Item/Package": "Item",
            "Description": "IBUPROFEN 400 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.71 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90595",
            "Item/Package": "Item",
            "Description": "PREDNISONE 5 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.71 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90675",
            "Item/Package": "Item",
            "Description": "SOTALOL HCL 80 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.71 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90592",
            "Item/Package": "Item",
            "Description": "PRAMIPEXOLE DI-HCL 0.25 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90632",
            "Item/Package": "Item",
            "Description": "RISPERIDONE 1 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90283",
            "Item/Package": "Item",
            "Description": "FOLIC ACID 1 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90671",
            "Item/Package": "Item",
            "Description": "SODIUM CHLORIDE 1 GM TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90254",
            "Item/Package": "Item",
            "Description": "EZETIMIBE 10 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90289",
            "Item/Package": "Item",
            "Description": "GABAPENTIN(NEURONTIN) 300 MG C",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90081",
            "Item/Package": "Item",
            "Description": "BENZOCAINE/MENTHOL (CHLORASEPT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90594",
            "Item/Package": "Item",
            "Description": "PREDNISONE 10 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90648",
            "Item/Package": "Item",
            "Description": "SIMVASTATIN(ZOCOR) 20 MG TABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90125",
            "Item/Package": "Item",
            "Description": "CARVEDILOL (COREG) 6.25 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90536",
            "Item/Package": "Item",
            "Description": "OMEPRAZOLE 20 MG CAP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90275",
            "Item/Package": "Item",
            "Description": "FLUOXETINE (PROZAC) 20 MG CAPS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90680",
            "Item/Package": "Item",
            "Description": "SULFAMETHOXAZOLE/TRIMETHOPRIM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90689",
            "Item/Package": "Item",
            "Description": "TEMAZEPAM(RESTORIL) 15 MG CAPS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90000",
            "Item/Package": "Item",
            "Description": "ACET/COD #3 (TYLENOL #3) 300MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90335",
            "Item/Package": "Item",
            "Description": "HYDROCHLOROTHIAZIDE 12.5 MG CA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90360",
            "Item/Package": "Item",
            "Description": "IBUPROFEN 600 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90471",
            "Item/Package": "Item",
            "Description": "METHOCARBAMOL (ROBAXIN) 500 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90622",
            "Item/Package": "Item",
            "Description": "PYRIDOXINE HCL 50 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90029",
            "Item/Package": "Item",
            "Description": "AMIODARONE(CORDARONE) 200MG TA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90019",
            "Item/Package": "Item",
            "Description": "ALBUTEROL SULFATE 2.5 MG/3 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90167",
            "Item/Package": "Item",
            "Description": "CLOPIDOGREL (PLAVIX) 75 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90334",
            "Item/Package": "Item",
            "Description": "HYDRALAZINE HCL 50 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90347",
            "Item/Package": "Item",
            "Description": "HYDROMORPHONE HCL 2 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90051",
            "Item/Package": "Item",
            "Description": "ATENOLOL (TENORMIN) 25 MG TABL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.93 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90313",
            "Item/Package": "Item",
            "Description": "GLYBURIDEMICRONIZED 3 MG TABL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.93 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90611",
            "Item/Package": "Item",
            "Description": "PROMETHAZINE HCL 25 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90153",
            "Item/Package": "Item",
            "Description": "CIPROFLOXACIN  500 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90624",
            "Item/Package": "Item",
            "Description": "QUINAPRIL HCL 5 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90302",
            "Item/Package": "Item",
            "Description": "GEMFIBROZIL (LOPID) 600 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.01 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90497",
            "Item/Package": "Item",
            "Description": "MIRTAZAPINE 15 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.02 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90470",
            "Item/Package": "Item",
            "Description": "METFORMIN (GLUCOPHAGE) 850 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.03 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90450",
            "Item/Package": "Item",
            "Description": "LORATADINE(CLARITIN) 10 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90728",
            "Item/Package": "Item",
            "Description": "VALSARTAN(DIOVAN) 40 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90677",
            "Item/Package": "Item",
            "Description": "SPIRONOLACTONE 25 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90017",
            "Item/Package": "Item",
            "Description": "ALBUTEROL (PROVENTIL HFA) INH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90110",
            "Item/Package": "Item",
            "Description": "BUSPIRONE (BUSPAR) 5 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90246",
            "Item/Package": "Item",
            "Description": "ESCITALOPRAM (LEXAPRO) 10 MG T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90084",
            "Item/Package": "Item",
            "Description": "BENZONATATE (TESSALON) 100 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90535",
            "Item/Package": "Item",
            "Description": "OLMESARTAN  20 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90575",
            "Item/Package": "Item",
            "Description": "PIOGLITAZONE HCL 15 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.13 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90740",
            "Item/Package": "Item",
            "Description": "VITAMIN D3 1000 UNITS TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90712",
            "Item/Package": "Item",
            "Description": "TRAZODONE HCL 50 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.16 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90825",
            "Item/Package": "Item",
            "Description": "QUETIAPINE FUMAR SEROQUEL 25MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90617",
            "Item/Package": "Item",
            "Description": "PROPRANOLOL HCL 10 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90255",
            "Item/Package": "Item",
            "Description": "FAMOTIDINE(PEPCID) 20 MG TABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.23 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90999",
            "Item/Package": "Item",
            "Description": "BUSPIRONE (BUSPAR) 10MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90868",
            "Item/Package": "Item",
            "Description": "GLIMEPIRIDE 2MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90314",
            "Item/Package": "Item",
            "Description": "GLYCERIN 1 EACH SUPP.RECT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90370",
            "Item/Package": "Item",
            "Description": "INSULIN REGULAR HUMAN 300 UNI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90338",
            "Item/Package": "Item",
            "Description": "HYDROCODONE/ACETAMINOPHEN (NOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90745",
            "Item/Package": "Item",
            "Description": "WARFARIN SODIUM 2.5 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90748",
            "Item/Package": "Item",
            "Description": "WARFARIN SODIUM 7.5 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90053",
            "Item/Package": "Item",
            "Description": "ATORVASTATIN (LIPTOR) 40 MG TA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90558",
            "Item/Package": "Item",
            "Description": "PAROXETINE HCL 20 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90747",
            "Item/Package": "Item",
            "Description": "WARFARIN SODIUM 5 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90623",
            "Item/Package": "Item",
            "Description": "QUETIAPINE FUMARATE 100 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90482",
            "Item/Package": "Item",
            "Description": "METOCLOPRAMIDE (REGLAN) 10MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90539",
            "Item/Package": "Item",
            "Description": "ONDANSETRON 4 MG TAB.RAPDIS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.40 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90142",
            "Item/Package": "Item",
            "Description": "CEPHALEXIN 500 MG CAPSULE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90382",
            "Item/Package": "Item",
            "Description": "ISOSORBIDE MONONITRATE 30 MG T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90402",
            "Item/Package": "Item",
            "Description": "LAMOTRIGINE (LAMICTAL) 100 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90454",
            "Item/Package": "Item",
            "Description": "LORAZEPAM(ATIVAN) 0.5 MG TABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90734",
            "Item/Package": "Item",
            "Description": "VENLAFAXINE(EFFEXOR) 50 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90090",
            "Item/Package": "Item",
            "Description": "BISACODYL 10 MG SUPP.RECT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90650",
            "Item/Package": "Item",
            "Description": "SIMVASTATIN(ZOCOR) 5 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90684",
            "Item/Package": "Item",
            "Description": "TAMSULOSIN(FLOMAX) 0.4 MG CAP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90003",
            "Item/Package": "Item",
            "Description": "ACETAMINOPHEN (TYLENOL) 120 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.58 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90036",
            "Item/Package": "Item",
            "Description": "AMOXICILLIN/CLAV (AUGMENTIN) 8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.58 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90613",
            "Item/Package": "Item",
            "Description": "PROPAFENONE HCL 150 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.58 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90206",
            "Item/Package": "Item",
            "Description": "DILTIAZEM CARDIZEM CD 120MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90337",
            "Item/Package": "Item",
            "Description": "HYDROCODONE/ACETAMINOPHEN (NOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90140",
            "Item/Package": "Item",
            "Description": "CEPHALEXIN (KEFLEX) 250 MG CAP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.62 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90409",
            "Item/Package": "Item",
            "Description": "LEVOFLOXACIN (LEVAQUIN) 500 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.62 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90383",
            "Item/Package": "Item",
            "Description": "ISOSORBIDE MONONITRATE 60 MG T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90546",
            "Item/Package": "Item",
            "Description": "OXYCODONE /ACETAMINOPHEN (PERC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90743",
            "Item/Package": "Item",
            "Description": "WARFARIN SODIUM 1 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90621",
            "Item/Package": "Item",
            "Description": "PSYLLIUM HUSK (WITH SUGAR) 3.4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90208",
            "Item/Package": "Item",
            "Description": "DILTIAZEM CARDIZEM CD 180MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.71 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90843",
            "Item/Package": "Item",
            "Description": "AMOXICILLIN 500MG CAP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90353",
            "Item/Package": "Item",
            "Description": "HYDROXYZINE HCL 10 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90214",
            "Item/Package": "Item",
            "Description": "DIPHENOXYLATE /ATROPINE (LOMOT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90679",
            "Item/Package": "Item",
            "Description": "SUCRALFATE 1 GM TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90032",
            "Item/Package": "Item",
            "Description": "AMMONIA 1 EACH AMPUL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90085",
            "Item/Package": "Item",
            "Description": "BENZTROPINE (COGENTIN) 1 MG TA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90499",
            "Item/Package": "Item",
            "Description": "MONTELUKAST (SINGULAIR) 10 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90880",
            "Item/Package": "Item",
            "Description": "BUTALB/ACET/ CAFFEIN FIORICET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90780",
            "Item/Package": "Item",
            "Description": "ARIPIPRAZOLE ABILIFY 10MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90708",
            "Item/Package": "Item",
            "Description": "TORSEMIDE 10 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90377",
            "Item/Package": "Item",
            "Description": "IPRATROPIUM/ALBUTEROL SULFATE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.93 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90414",
            "Item/Package": "Item",
            "Description": "LEVOTHYROXINE SODIUM 25 MCG TA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.94 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90653",
            "Item/Package": "Item",
            "Description": "SOD CHL 0.9% 10 ML FLUSH SYRIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.94 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91016",
            "Item/Package": "Item",
            "Description": "ERGOCALCIFEROL VIT D2 50,000U",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90319",
            "Item/Package": "Item",
            "Description": "GUAIFENESIN 600 MG TBBP.12HR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90065",
            "Item/Package": "Item",
            "Description": "BACLOFEN (LIORESAL) 10 MG TABL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90545",
            "Item/Package": "Item",
            "Description": "OXYBUTYNIN CHLORIDE 5 MG TABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90355",
            "Item/Package": "Item",
            "Description": "HYDROXYZINE PAMOATE 25 MG CAPS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90584",
            "Item/Package": "Item",
            "Description": "POT CHLORIDE (K-DUR) 10 MEQ TA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90022",
            "Item/Package": "Item",
            "Description": "ALLOPURINOL (ZYLOPRIM) 100 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.15 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90307",
            "Item/Package": "Item",
            "Description": "GLIMEPIRIDE 4 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.16 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90312",
            "Item/Package": "Item",
            "Description": "GLYBURIDE 5 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.16 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90030",
            "Item/Package": "Item",
            "Description": "AMITRIPTYLINE (ELAVIL) 25 MG T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90498",
            "Item/Package": "Item",
            "Description": "MISOPROSTOL 100 MCG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90403",
            "Item/Package": "Item",
            "Description": "LAMOTRIGINE (LAMICTAL) 25 MG T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90585",
            "Item/Package": "Item",
            "Description": "POT CHLORIDE (K-DUR) 20 MEQ TA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90455",
            "Item/Package": "Item",
            "Description": "LOSARTAN (COZAAR) 50 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90746",
            "Item/Package": "Item",
            "Description": "WARFARIN SODIUM 3 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90309",
            "Item/Package": "Item",
            "Description": "GLIPIZIDE 5 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90494",
            "Item/Package": "Item",
            "Description": "MIDAZOLAM HCL 2 MG/2 ML MLS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90290",
            "Item/Package": "Item",
            "Description": "GABAPENTIN(NEURONTIN) 800 MG T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90582",
            "Item/Package": "Item",
            "Description": "POT BICARB (K-LYTE) 25 MEQ TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90398",
            "Item/Package": "Item",
            "Description": "LABETALOL 100 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90642",
            "Item/Package": "Item",
            "Description": "SERTRALINE(ZOLOFT) 50 MG TABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90795",
            "Item/Package": "Item",
            "Description": "MEMANTINE NAMENDA 5MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90631",
            "Item/Package": "Item",
            "Description": "REPAGLINIDE(PRANDIN) 0.5 MG TA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91018",
            "Item/Package": "Item",
            "Description": "PHOS NAK PKTS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90207",
            "Item/Package": "Item",
            "Description": "DILTIAZEM 120 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90485",
            "Item/Package": "Item",
            "Description": "METOPROLOL SUCCINATE (TOPROL X",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90866",
            "Item/Package": "Item",
            "Description": "KETAMINE 50MG/ML (PER ML)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.45 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90415",
            "Item/Package": "Item",
            "Description": "LEVOTHYROXINE SODIUM 50 MCG TA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90552",
            "Item/Package": "Item",
            "Description": "OXYCODONE HCL 20 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90654",
            "Item/Package": "Item",
            "Description": "SOD CHL 0.9% 10ML FLUSH SYRIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90109",
            "Item/Package": "Item",
            "Description": "BUPROPION (WELLBUTRIN) 150 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91020",
            "Item/Package": "Item",
            "Description": "HEPARIN(HEPLOCK) 100U/ML 5ML V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90399",
            "Item/Package": "Item",
            "Description": "LABETALOL 100 MG/20 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90486",
            "Item/Package": "Item",
            "Description": "METOPROLOL SUCCINATE (TOPROL X",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90339",
            "Item/Package": "Item",
            "Description": "HYDROCODONE/ACETAMINOPHEN (NOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90707",
            "Item/Package": "Item",
            "Description": "TOPIRAMATE 50 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90198",
            "Item/Package": "Item",
            "Description": "DICYCLOMINE (BENTYL) 10 MG CAP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90463",
            "Item/Package": "Item",
            "Description": "MECLIZINE (DRAMAMINE) 25 MG TA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90553",
            "Item/Package": "Item",
            "Description": "OXYCODONE HCL 5 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90701",
            "Item/Package": "Item",
            "Description": "TIZANIDINE(ZANAFLEX) 4 MG TABL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90491",
            "Item/Package": "Item",
            "Description": "METRONIDAZOLE 500 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90007",
            "Item/Package": "Item",
            "Description": "ACETAMINOPHEN (TYLENOL) 650 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90417",
            "Item/Package": "Item",
            "Description": "LEVOTHYROXINE SODIUM 88 MCG TA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90271",
            "Item/Package": "Item",
            "Description": "FLUDROCORTISONE  0.1 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90860",
            "Item/Package": "Item",
            "Description": "GABAPENTIN(NEURONTIN) 600 MG T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90735",
            "Item/Package": "Item",
            "Description": "VENLAFAXINE(EFFEXOR XR)150 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90502",
            "Item/Package": "Item",
            "Description": "MORPHINE SULFATE 15 MG TABLET.",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90726",
            "Item/Package": "Item",
            "Description": "VALACYCLOVIR(VALTREX) 500 MG T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90396",
            "Item/Package": "Item",
            "Description": "KETOROLAC 10 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.02 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90079",
            "Item/Package": "Item",
            "Description": "BENAZEPRIL (LOTENSIN) 10 MG TA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.06 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91028",
            "Item/Package": "Item",
            "Description": "RIFAMPIN 300MG CAPSULES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90566",
            "Item/Package": "Item",
            "Description": "PHENOBARBITAL 32.4 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90862",
            "Item/Package": "Item",
            "Description": "VENLAFAXINE(EFFEXOR XR) 75 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90412",
            "Item/Package": "Item",
            "Description": "LEVOTHYROXINE SODIUM 112 MCG T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90688",
            "Item/Package": "Item",
            "Description": "TELMISARTAN(MICARDIS) 80 MG TA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90060",
            "Item/Package": "Item",
            "Description": "AZITHROMYCIN(ZITHROMAX) 250MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90719",
            "Item/Package": "Item",
            "Description": "TRIAMTERENE/HYDROCHLOROTHIAZID",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90401",
            "Item/Package": "Item",
            "Description": "LACTULOSE 10 GM/15 ML MLS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90410",
            "Item/Package": "Item",
            "Description": "LEVOTHYROXINE SODIUM 100 MCG T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90120",
            "Item/Package": "Item",
            "Description": "CARBAMAZEPINE (TEGRETOL) 200 M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90452",
            "Item/Package": "Item",
            "Description": "LORATADINE/PSEUDOEPH (CLARITIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90453",
            "Item/Package": "Item",
            "Description": "LORAZEPAM (ATIVAN) 2 MG/ML  1M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.58 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90597",
            "Item/Package": "Item",
            "Description": "PREGABALIN 75 MG CAPSULE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90556",
            "Item/Package": "Item",
            "Description": "OXYTOCIN 10 UNIT/ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90318",
            "Item/Package": "Item",
            "Description": "GUAIFENESIN 100 MG/5 ML ORAL S",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90681",
            "Item/Package": "Item",
            "Description": "SUMATRIPTAN SUCCINATE 50 MG TA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90799",
            "Item/Package": "Item",
            "Description": "SILVER NITRATE APPLICATOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90416",
            "Item/Package": "Item",
            "Description": "LEVOTHYROXINE SODIUM 75 MCG TA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90256",
            "Item/Package": "Item",
            "Description": "FAMOTIDINE(PEPCID) 20 MG/2 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90571",
            "Item/Package": "Item",
            "Description": "PHENYTOIN SODIUM EXTENDED 100",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90413",
            "Item/Package": "Item",
            "Description": "LEVOTHYROXINE SODIUM 175 MCG T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90449",
            "Item/Package": "Item",
            "Description": "LOPERAMIDE(IMMODIUM) 2 MG CAPS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90230",
            "Item/Package": "Item",
            "Description": "ENALAPRIL 20 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.02 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90790",
            "Item/Package": "Item",
            "Description": "HYDROGEN PEROXIDE 16OZ SOLN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.06 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90563",
            "Item/Package": "Item",
            "Description": "PHENAZOPYRIDINE HCL 100 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.23 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90670",
            "Item/Package": "Item",
            "Description": "SODIUM CHLORIDE 1 EACH SPRAY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90619",
            "Item/Package": "Item",
            "Description": "PROPRANOLOL (INDERAL) 60MG CAP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90231",
            "Item/Package": "Item",
            "Description": "ENALAPRIL 5 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90266",
            "Item/Package": "Item",
            "Description": "FLEETS ENEMA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90308",
            "Item/Package": "Item",
            "Description": "GLIPIZIDE 5 MG TAB.ER.24",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90264",
            "Item/Package": "Item",
            "Description": "FINASTERIDE(PROSCAR) 5 MG TABL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90652",
            "Item/Package": "Item",
            "Description": "SOD CHL 0.9% 10 ML FLUSH SYRIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90395",
            "Item/Package": "Item",
            "Description": "KETOROLAC (TORADOL) 30 MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90634",
            "Item/Package": "Item",
            "Description": "RIZATRIPTAN BENZOATE(MAXALT ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90612",
            "Item/Package": "Item",
            "Description": "PROMETHAZINE HCL 25 MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90538",
            "Item/Package": "Item",
            "Description": "ONDANSETRON 2 MG/ML VIAL 20 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90520",
            "Item/Package": "Item",
            "Description": "NITROFURANTOIN MONO(MACROBID)1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.13 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90321",
            "Item/Package": "Item",
            "Description": "GUAIFENESIN DM ROBITUSIN DM 10",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90909",
            "Item/Package": "Item",
            "Description": "OMNIPAQUE 300MG/ML 50ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90418",
            "Item/Package": "Item",
            "Description": "LIDOCAINE  1% 10 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90548",
            "Item/Package": "Item",
            "Description": "OXYCODONE /ACETAMINOPHEN 10 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90656",
            "Item/Package": "Item",
            "Description": "SOD CHLORIDE 0.9% 10 ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90503",
            "Item/Package": "Item",
            "Description": "MORPHINE SULFATE 30 MG TABLET.",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90351",
            "Item/Package": "Item",
            "Description": "HYDROXYCHLOROQUINE SULFATE 200",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90543",
            "Item/Package": "Item",
            "Description": "OXCARBAZEPINE 150 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90483",
            "Item/Package": "Item",
            "Description": "METOCLOPRAMIDE(REGLAN) 10MG/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90668",
            "Item/Package": "Item",
            "Description": "SOD CHLORIDE 0.9% 1 EACH BA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90693",
            "Item/Package": "Item",
            "Description": "TETRAHYDROZOLINE (OPTI-CLEAR)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.01 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90326",
            "Item/Package": "Item",
            "Description": "HEPARIN 5000 UNIT/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90456",
            "Item/Package": "Item",
            "Description": "MAG-AL PLUS (MAALOX) 30 ML ORA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.31 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90500",
            "Item/Package": "Item",
            "Description": "MORPHINE SULFATE 10 MG/5 ML ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90830",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE PF 0.5% 10ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90727",
            "Item/Package": "Item",
            "Description": "VALSARTAN(DIOVAN) 160 MG TABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90380",
            "Item/Package": "Item",
            "Description": "ISOPROPYL ALCOHOL 473 ML SOLUT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90406",
            "Item/Package": "Item",
            "Description": "LEVALBUTEROL(XOPENEX)1.25 MG/3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90519",
            "Item/Package": "Item",
            "Description": "NIFEDIPINE XL ER(PROCARDIA XL)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90427",
            "Item/Package": "Item",
            "Description": "LIDOCAINE 2% /PF  5 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90004",
            "Item/Package": "Item",
            "Description": "ACETAMINOPHEN (TYLENOL) 325 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90897",
            "Item/Package": "Item",
            "Description": "SODIUM CHLR/HYPERTONIC 3%500ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90106",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE/PF 0.5% 30 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.16 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90517",
            "Item/Package": "Item",
            "Description": "NICOTINE 14 MG PATCH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.16 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90618",
            "Item/Package": "Item",
            "Description": "PROPRANOLOL HCL 40 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90661",
            "Item/Package": "Item",
            "Description": "SOD CHLORIDE 100 ML ADDVAN BAG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90547",
            "Item/Package": "Item",
            "Description": "OXYCODONE /ACETAMINOPHEN (PERC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90213",
            "Item/Package": "Item",
            "Description": "DIPHENHYDRAMINE 50 MG/ML VL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90139",
            "Item/Package": "Item",
            "Description": "CELECOXIB (CELEBREX) 200 MG CA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90105",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE/PF 0.25% 30 ML VIA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90368",
            "Item/Package": "Item",
            "Description": "INSULIN LISPRO (HUMALOG) 300 U",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90994",
            "Item/Package": "Item",
            "Description": "VERAPAMIL HCL 180MG TAB.ER 24",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90096",
            "Item/Package": "Item",
            "Description": "BUMETANIDE 1 MG (BUMEX) TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90464",
            "Item/Package": "Item",
            "Description": "MEMANTINE (NAMENDA) 10 MG TABL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90043",
            "Item/Package": "Item",
            "Description": "ARMOUR THYROID 30MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90484",
            "Item/Package": "Item",
            "Description": "METOLAZONE (ZAROXOLYN) 5MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "539",
            "Item/Package": "Item",
            "Description": "LACTATED RINGERS 1000ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90357",
            "Item/Package": "Item",
            "Description": "IBUPROFEN 100 MG/5 ML ORAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.13 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90062",
            "Item/Package": "Item",
            "Description": "BACITRACIN 28GM TUBE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90625",
            "Item/Package": "Item",
            "Description": "RACEPINEPHRINE 2.25% NEB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90458",
            "Item/Package": "Item",
            "Description": "MAGNESIUM HYDROXIDE(MOM) 30 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90914",
            "Item/Package": "Item",
            "Description": "LIDOCAINE 1% PF 10 MG/ML PAIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90039",
            "Item/Package": "Item",
            "Description": "AMPICILLIN SODIUM 1 GM VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90850",
            "Item/Package": "Item",
            "Description": "OMNIPAQUE 240MG/ML 10ML BOTTLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90518",
            "Item/Package": "Item",
            "Description": "NICOTINE 21 MG PATCH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90148",
            "Item/Package": "Item",
            "Description": "CHLORHEXIDINE GLUCO PERIDEX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90490",
            "Item/Package": "Item",
            "Description": "METRONIDAZOLE (FLAGYL) 500 MG/",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90199",
            "Item/Package": "Item",
            "Description": "DIGOXIN 125 MCG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.03 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90228",
            "Item/Package": "Item",
            "Description": "DULOXETINE 30 MG CAPSULE.DR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.03 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90581",
            "Item/Package": "Item",
            "Description": "POLY GLYCO (MIRALAX) 17 GM POW",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90750",
            "Item/Package": "Item",
            "Description": "WATER FOR INJ STERILE 1000ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90101",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE -DEXTR 0.75% / PF",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90102",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE PF 0.25% 10ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90596",
            "Item/Package": "Item",
            "Description": "PREGABALIN 25 MG CAPSULE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90504",
            "Item/Package": "Item",
            "Description": "MORPHINE SULFATE 4 MG/ML MLS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90496",
            "Item/Package": "Item",
            "Description": "MINERAL OIL 25 ML OIL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90819",
            "Item/Package": "Item",
            "Description": "WATER STERILE 20ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90225",
            "Item/Package": "Item",
            "Description": "DOXEPIN  25 MG CAPSULE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5004",
            "Item/Package": "Item",
            "Description": "SOD CHLORIDE 0.45% 1000ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90226",
            "Item/Package": "Item",
            "Description": "DOXYCYCLINE  100 MG CAPSULE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90662",
            "Item/Package": "Item",
            "Description": "SOD CHLORIDE 250 ML ADDVAN BAG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90108",
            "Item/Package": "Item",
            "Description": "BUPIVAC-EPI PF 0.5% 1:2OOK 10M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90521",
            "Item/Package": "Item",
            "Description": "NITROGLYCERIN 0.4 MG TAB.SUBL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90224",
            "Item/Package": "Item",
            "Description": "DOXAZOSIN  2 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90569",
            "Item/Package": "Item",
            "Description": "PHENYLEPHRINE  10 MG/ML 1ML VI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90364",
            "Item/Package": "Item",
            "Description": "INDOMETHACIN 75 MG CAPSULE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90092",
            "Item/Package": "Item",
            "Description": "BISMUTH SUBSALICYLATE (PEPTO B",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90442",
            "Item/Package": "Item",
            "Description": "LIDOCAINE-EPI 2% 20 ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.37 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90035",
            "Item/Package": "Item",
            "Description": "AMOXICILLIN 250 MG/5 ML 100 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90889",
            "Item/Package": "Item",
            "Description": "CHLORASERPTIC (SUGFREE) SPRAY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90796",
            "Item/Package": "Item",
            "Description": "METHADONE 10MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "S0109",
            " Charge Amount ": " $10.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90894",
            "Item/Package": "Item",
            "Description": "MORPHINE SULFATE 2MG/ML SYRING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90438",
            "Item/Package": "Item",
            "Description": "LIDOCAINE/PF 1% 30 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90440",
            "Item/Package": "Item",
            "Description": "LIDOCAINE-EPI 1% 1:100000 20",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.01 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90258",
            "Item/Package": "Item",
            "Description": "FENOFIBRATE(TRICOR) 145 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90792",
            "Item/Package": "Item",
            "Description": "LIDOCAINE MDV XYLO 2%/ 50ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90131",
            "Item/Package": "Item",
            "Description": "CEFAZOLIN(ANCEF) 1 GM VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90419",
            "Item/Package": "Item",
            "Description": "LIDOCAINE  2%/MPF 5 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.31 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90408",
            "Item/Package": "Item",
            "Description": "LEVOFLOXACIN (LEVAQUIN) 500 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90170",
            "Item/Package": "Item",
            "Description": "CLOTRIMAZOLE(LOTRIMIN)1% CREAM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.45 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90706",
            "Item/Package": "Item",
            "Description": "TOLTERODINE TARTRATE 4 MG CAP.",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90286",
            "Item/Package": "Item",
            "Description": "FUROSEMIDE(LASIX) 10 MG/ML IV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90467",
            "Item/Package": "Item",
            "Description": "MEPERIDINE(DEMEROL) 50 MG/ML I",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90921",
            "Item/Package": "Item",
            "Description": "VALSARTAN (DIOVAN) 80MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90155",
            "Item/Package": "Item",
            "Description": "CIPROFLOXACIN (CIPRO) 400 MG/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90858",
            "Item/Package": "Item",
            "Description": "HYDROMORPHONE 0.5MG/0.5ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90544",
            "Item/Package": "Item",
            "Description": "OXYBUTYNIN CHLORIDE 5 MG TAB.E",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90722",
            "Item/Package": "Item",
            "Description": "TROPICAMIDE (MYDRIACYL) 1% OPH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90568",
            "Item/Package": "Item",
            "Description": "PHENOL(CHLORASEPTIC)SPRAY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90794",
            "Item/Package": "Item",
            "Description": "XYLOCAINE EPI  MPF 1% 1:200K",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90099",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE 0.5% 5 MG/ML 50ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90669",
            "Item/Package": "Item",
            "Description": "SOD CHLORIDE 0.9% 50 ML BAG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90001",
            "Item/Package": "Item",
            "Description": "ACET/COD (TYLENOL/COD) 120 MG/",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90501",
            "Item/Package": "Item",
            "Description": "MORPHINE SULFATE 10 MG/ML MLS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90441",
            "Item/Package": "Item",
            "Description": "LIDOCAINE-EPI 1% 50 ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90911",
            "Item/Package": "Item",
            "Description": "LEVOFLOXACIN/D5W 250MG/50ML PR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90261",
            "Item/Package": "Item",
            "Description": "FENTANYL(DURAGESIC) 25 MCG/HR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90100",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE 0.5% 50 ML MDV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90407",
            "Item/Package": "Item",
            "Description": "LEVOBUNOLOL(BETAGAN)0.5% OPHTH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90212",
            "Item/Package": "Item",
            "Description": "DIPHENHYDRAMINE 12.5 MG/5 ML O",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90160",
            "Item/Package": "Item",
            "Description": "CLINDAMYCIN (CLEOCIN) 150 MG/M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90657",
            "Item/Package": "Item",
            "Description": "SOD CHLORIDE 0.9% 100 ML BAG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90388",
            "Item/Package": "Item",
            "Description": "KCL (20 MEQ)/D5-0.9%NACL/1000",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90730",
            "Item/Package": "Item",
            "Description": "VANCOMYCIN 1 GM VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90660",
            "Item/Package": "Item",
            "Description": "SOD CHLORIDE 0.9% 500 ML BAG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90586",
            "Item/Package": "Item",
            "Description": "POT CHLORIDE 10 MEQ/100 ML PRE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90098",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE 0.25% 50ML MDV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90583",
            "Item/Package": "Item",
            "Description": "POT CHLORIDE (KCL) 2 MEQ/ML VI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90247",
            "Item/Package": "Item",
            "Description": "ESMOLOL 100 MG/10 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90040",
            "Item/Package": "Item",
            "Description": "AMPICILLIN SODIUM 2 GM VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90555",
            "Item/Package": "Item",
            "Description": "OXYMETAZOLINE HCL (NASAL DECON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90346",
            "Item/Package": "Item",
            "Description": "HYDROMORPHONE 2 MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90731",
            "Item/Package": "Item",
            "Description": "VANCOMYCIN 500 MG VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90864",
            "Item/Package": "Item",
            "Description": "HEPARIN(PICC LINE) 10UNITS/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90801",
            "Item/Package": "Item",
            "Description": "SOD CHLOR ALOE VERA GEL TUBE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.71 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90009",
            "Item/Package": "Item",
            "Description": "ACETAZOLAMIDE (DIAMOX) 250 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90252",
            "Item/Package": "Item",
            "Description": "ETOMIDATE 2 MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90387",
            "Item/Package": "Item",
            "Description": "KCL (20 MEQ)/D5-0.45%NACL/100",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90270",
            "Item/Package": "Item",
            "Description": "FLUCONAZOLE (DIFLUCAN)100 MG T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90233",
            "Item/Package": "Item",
            "Description": "ENOXAPARIN (LOVENOX) 30 MG/0.3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90262",
            "Item/Package": "Item",
            "Description": "FENTANYL(DURAGESIC) 50 MCG/HR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90800",
            "Item/Package": "Item",
            "Description": "SILVER SULFADIAZINE 1% CREAM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90422",
            "Item/Package": "Item",
            "Description": "LIDOCAINE 0.5% 50 ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90385",
            "Item/Package": "Item",
            "Description": "KCL (20 MEQ)/0.9%NACL/1000 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90428",
            "Item/Package": "Item",
            "Description": "LIDOCAINE 2% 10 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90861",
            "Item/Package": "Item",
            "Description": "BUPIVOCAINE/EPI/PF 0.25% 10ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90509",
            "Item/Package": "Item",
            "Description": "NADOLOL 20 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90839",
            "Item/Package": "Item",
            "Description": "NAPHAZ/PHERAM NAPHCON A 5ML GT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90557",
            "Item/Package": "Item",
            "Description": "PANTOPRAZOLE SODIUM 40 MG VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90367",
            "Item/Package": "Item",
            "Description": "INSULIN GLARGINEHUM.ANLOG 10",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90164",
            "Item/Package": "Item",
            "Description": "CLINDAMYCIN 900 MG/6 ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90443",
            "Item/Package": "Item",
            "Description": "LIDOCAINE-MPF 1%-EPI 1:200000",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90900",
            "Item/Package": "Item",
            "Description": "DIAZEPAM 5MG/ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90658",
            "Item/Package": "Item",
            "Description": "SOD CHLORIDE 0.9% 250 ML BAG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90433",
            "Item/Package": "Item",
            "Description": "LIDOCAINE 2%/PF 5 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90205",
            "Item/Package": "Item",
            "Description": "DILTIAZEM (CARDIZEM) 5 MG/ML V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91011",
            "Item/Package": "Item",
            "Description": "LIDO-EPI (XYLO) 1% 1:100K 30ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.01 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90834",
            "Item/Package": "Item",
            "Description": "TRIAMCINLNE/KENALOG 0.025% CR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90958",
            "Item/Package": "Item",
            "Description": "DEXMEDETOMIDINE HCL 200MCG/2ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90420",
            "Item/Package": "Item",
            "Description": "LIDOCAINE  4%/PF 5 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90232",
            "Item/Package": "Item",
            "Description": "ENALAPRILAT (ENALAPRIL) 1.25 M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90175",
            "Item/Package": "Item",
            "Description": "CYANOCOBALAMIN (VITAMIN B-12)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90805",
            "Item/Package": "Item",
            "Description": "NON-FORMULARY MED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90865",
            "Item/Package": "Item",
            "Description": "HYDROCODONE/ACET 7.5-325 15ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90400",
            "Item/Package": "Item",
            "Description": "LABETALOL 100 MG/20 ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90348",
            "Item/Package": "Item",
            "Description": "HYDROMORPHONE HCL/PF 1 MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90508",
            "Item/Package": "Item",
            "Description": "MUPIROCIN(BACTROBAN) 2% OINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90895",
            "Item/Package": "Item",
            "Description": "LIDOCAINE PF 1.5% 15MG/ML PAIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90234",
            "Item/Package": "Item",
            "Description": "ENOXAPARIN (LOVENOX) 40 MG/0.4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90201",
            "Item/Package": "Item",
            "Description": "DIGOXIN 250 MCG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90103",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE/EPI 0.5% 50 ML VIA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $21.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90269",
            "Item/Package": "Item",
            "Description": "FLUCONAZOLE (DIFLUCAN) 200 MG/",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $21.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90531",
            "Item/Package": "Item",
            "Description": "NYSTATIN CREAM 15 GM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $21.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90147",
            "Item/Package": "Item",
            "Description": "CHLORHEXIDINE GLU HIBICLENS 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $21.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90021",
            "Item/Package": "Item",
            "Description": "ALFENTANIL 1000 MCG/ML 2ML AMP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $21.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90922",
            "Item/Package": "Item",
            "Description": "ROPIVACAINE PF 0.2% 2MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $22.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90278",
            "Item/Package": "Item",
            "Description": "FLUTICASONE(FLONASE) 120 SPRAY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $22.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90990",
            "Item/Package": "Item",
            "Description": "WATER STERILE INJ 5ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $22.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90303",
            "Item/Package": "Item",
            "Description": "GENTAMICIN 0.3% OPHTH DROPS 5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $22.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90173",
            "Item/Package": "Item",
            "Description": "CODEINE SULFATE 15 MG/2.5 ML O",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $23.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90465",
            "Item/Package": "Item",
            "Description": "MEPERIDINE(DEMEROL) 25 MG/ML I",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $23.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90426",
            "Item/Package": "Item",
            "Description": "LIDOCAINE 1% 50 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90174",
            "Item/Package": "Item",
            "Description": "COLCHICINE 0.6 MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90646",
            "Item/Package": "Item",
            "Description": "SIMETHICONE(MYLICON) INFANTS G",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90304",
            "Item/Package": "Item",
            "Description": "GENTAMICIN 80 MG/100 ML PREMIX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90394",
            "Item/Package": "Item",
            "Description": "KETOROLAC (ACULAR) 0.5% OPHTH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $25.02 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90404",
            "Item/Package": "Item",
            "Description": "LATANOPROST(XALATAN)0.005% OPH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $25.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90510",
            "Item/Package": "Item",
            "Description": "NALOXONE 0.4 MG/ML (NARCAN)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $25.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90733",
            "Item/Package": "Item",
            "Description": "VECURONIUM BROMIDE 10 MG VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $25.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90299",
            "Item/Package": "Item",
            "Description": "GELATIN (GELFOAM 12) 1 EACH SP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $26.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90481",
            "Item/Package": "Item",
            "Description": "METHYLPREDNISOLONE(SOLU-MEDROL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $26.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90550",
            "Item/Package": "Item",
            "Description": "OXYCODONE HCL (OXYCONTIN) 10 M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90389",
            "Item/Package": "Item",
            "Description": "KCL (20 MEQ)/LR-D5/1000 ML PR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90325",
            "Item/Package": "Item",
            "Description": "HEPARIN 10000 UNIT/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90010",
            "Item/Package": "Item",
            "Description": "ACETIC ACID 250 ML IRRIG.SOLN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.71 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90587",
            "Item/Package": "Item",
            "Description": "POT CHLORIDE 20 MEQ/15 ML ORAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90635",
            "Item/Package": "Item",
            "Description": "ROCURONIUM BROMIDE 10 MG/ML VI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90881",
            "Item/Package": "Item",
            "Description": "BIOTENE MOISTURE MOUTH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90905",
            "Item/Package": "Item",
            "Description": "NALOXEGOL OXALATE 25MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90431",
            "Item/Package": "Item",
            "Description": "LIDOCAINE 2% UROJET 5ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $29.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90700",
            "Item/Package": "Item",
            "Description": "TIMOLOL MALEATE (TIMOPTIC) 0.5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $29.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90892",
            "Item/Package": "Item",
            "Description": "NEBIVOLOL BYSTOLIC 5MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $30.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $21.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90878",
            "Item/Package": "Item",
            "Description": "NEOSTIGMINE (BLOXIVERZ) 1MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $30.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $21.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90121",
            "Item/Package": "Item",
            "Description": "CARBAMIDE PEROXIDE (EAR WAX) D",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $32.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $22.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90906",
            "Item/Package": "Item",
            "Description": "LIDOCAINE 10ML JELLY UROJT AUI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $32.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $22.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90195",
            "Item/Package": "Item",
            "Description": "DIBUCAINE 1% OINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $33.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90729",
            "Item/Package": "Item",
            "Description": "VANCOMYCIN 1 GM ADV VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $33.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90161",
            "Item/Package": "Item",
            "Description": "CLINDAMYCIN (CLEOCIN) 900 MG/5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $34.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90063",
            "Item/Package": "Item",
            "Description": "BACITRACIN 50000 UNIT VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $34.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90615",
            "Item/Package": "Item",
            "Description": "PROPOFOL 10 MG/ML 50MLS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $34.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90627",
            "Item/Package": "Item",
            "Description": "RANITIDINE 50 MG/2 ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $35.23 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90272",
            "Item/Package": "Item",
            "Description": "FLUMAZENIL(ROMAZICON)0.1 MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $35.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90163",
            "Item/Package": "Item",
            "Description": "CLINDAMYCIN 600 MG/50 ML PREMI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $36.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $25.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90489",
            "Item/Package": "Item",
            "Description": "METOPROLOL TARTRATE(LOPRESSOR)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $36.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $25.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90628",
            "Item/Package": "Item",
            "Description": "REFRESH LACRI-LUBE OINTMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $37.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90887",
            "Item/Package": "Item",
            "Description": "LABETALOL 5MG/ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $37.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90384",
            "Item/Package": "Item",
            "Description": "KCL (20 MEQ)/0.45%NACL/1000 M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $38.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90609",
            "Item/Package": "Item",
            "Description": "PROMETHAZINE HCL 12.5 MG SUPP.",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $38.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90686",
            "Item/Package": "Item",
            "Description": "TAPENTADOL(NUCYNTA) 50 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $39.03 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90437",
            "Item/Package": "Item",
            "Description": "LIDOCAINE/D5W 4 MG/ML 500 ML P",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $39.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90186",
            "Item/Package": "Item",
            "Description": "DEXTROSE 25 % IN WATER 10 ML S",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $40.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $28.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90525",
            "Item/Package": "Item",
            "Description": "NOREPINEPHRINE BITARTRATE 1 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $40.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $28.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90682",
            "Item/Package": "Item",
            "Description": "SUMATRIPTAN SUCCINATE 6 MG/0.5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $40.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $28.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90915",
            "Item/Package": "Item",
            "Description": "ALFENTANIL 500MCG/ML 5ML AMP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $41.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $28.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90851",
            "Item/Package": "Item",
            "Description": "APIXABAN (ELIQUIS) 5MG TABLET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $41.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $28.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90436",
            "Item/Package": "Item",
            "Description": "LIDOCAINE VISCOUS 100 ML SOLUT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $41.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90008",
            "Item/Package": "Item",
            "Description": "ACETAMINOPHEN (TYLENOL)160 MG/",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $41.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90917",
            "Item/Package": "Item",
            "Description": "APIXABAN (ELIQUIS) 2.5MG TABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $42.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90793",
            "Item/Package": "Item",
            "Description": "XYLOCAINE EPI MD1% 1:100K 50ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $42.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90480",
            "Item/Package": "Item",
            "Description": "METHYLPREDNISOLONE(SOLU-MEDROL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $42.94 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $30.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90674",
            "Item/Package": "Item",
            "Description": "SODIUM POLYSTYRENE SULFONATE(S",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $44.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $31.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90190",
            "Item/Package": "Item",
            "Description": "DEXTROSE 50 % IN WATER 50 ML S",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $45.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $31.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90430",
            "Item/Package": "Item",
            "Description": "LIDOCAINE 2% 5 ML JELLY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $46.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $32.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90493",
            "Item/Package": "Item",
            "Description": "MIDAZOLAM HCL 10 MG/5 ML MLS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $46.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $32.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91001",
            "Item/Package": "Item",
            "Description": "METHOCARBAMOL ROBAXIN 750MG TB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $47.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $33.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90421",
            "Item/Package": "Item",
            "Description": "LIDOCAINE (LIDODERM) PATCH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $47.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $33.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90116",
            "Item/Package": "Item",
            "Description": "CALCIUM CHLORIDE 100 MG/ML SYR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $49.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $34.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90379",
            "Item/Package": "Item",
            "Description": "ISOFLURANE (FORANE) 100 ML LIQ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $49.23 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $34.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90663",
            "Item/Package": "Item",
            "Description": "SODIUM BICARB INFANT 5MEQ/10ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $49.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $34.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90235",
            "Item/Package": "Item",
            "Description": "ENOXAPARIN (LOVENOX) 60 MG/0.6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $50.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $35.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90328",
            "Item/Package": "Item",
            "Description": "HEPARIN /D5W 25,000/500ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $50.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $35.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90237",
            "Item/Package": "Item",
            "Description": "ENOXAPARIN (LOVENOX)100 MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $51.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $35.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90393",
            "Item/Package": "Item",
            "Description": "KCL (40 MEQ)/D5-0.9%NACL/1000",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $51.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $36.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90591",
            "Item/Package": "Item",
            "Description": "POV-IODINE (BETADINE) 30 ML OP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $51.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $36.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90710",
            "Item/Package": "Item",
            "Description": "TRANEXAMIC ACID 1000 MG/10 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $52.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $36.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90236",
            "Item/Package": "Item",
            "Description": "ENOXAPARIN (LOVENOX) 80 MG/0.8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $53.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $37.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90691",
            "Item/Package": "Item",
            "Description": "TETRACAINE 0.5% OPHTH DROPS 2M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $57.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $40.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90128",
            "Item/Package": "Item",
            "Description": "CEFAZOLIN (ANCEF) 2 GM/50 ML P",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $58.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $40.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90901",
            "Item/Package": "Item",
            "Description": "POLYMYXIN B SULFATE 500,000U",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $58.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $41.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90513",
            "Item/Package": "Item",
            "Description": "NEO/POLY/DEX(MAXITROL) OPHTH D",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $59.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $41.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90797",
            "Item/Package": "Item",
            "Description": "POVIDONE IODINE BEDALINE 8OZ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $61.93 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90182",
            "Item/Package": "Item",
            "Description": "DEXAMETHASONE 4 MG/ML 30ML VL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $63.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $44.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90904",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE/EPI 0.25% 50ML MDV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $63.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $44.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90468",
            "Item/Package": "Item",
            "Description": "MEPIVACAINE(CARBOCAINE)PF 15 M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $64.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $45.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90809",
            "Item/Package": "Item",
            "Description": "SOD FERRIC GLUC/SUCR 62.5MG/5M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $65.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $45.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90238",
            "Item/Package": "Item",
            "Description": "EPHEDRINE SULFATE 50 MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $68.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $48.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90828",
            "Item/Package": "Item",
            "Description": "HETASTARCH 500 ML BAG PREMIX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $68.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $48.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90204",
            "Item/Package": "Item",
            "Description": "DILTIAZEM (CARDIZEM) 100 MG AD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $69.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $48.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90507",
            "Item/Package": "Item",
            "Description": "MOXIFLOXACIN (VIGAMOX) 0.5% OP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $69.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $48.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90119",
            "Item/Package": "Item",
            "Description": "CARBACHOL 1.5 ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $70.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $49.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90787",
            "Item/Package": "Item",
            "Description": "FERRIC SUBSULFATE 60 APL/60ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $71.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $50.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90704",
            "Item/Package": "Item",
            "Description": "TOBRAMYCIN (TOBREX) 0.3% OPHTH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $76.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $53.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90127",
            "Item/Package": "Item",
            "Description": "CEFAZOLIN (ANCEF) 1 GM/50 ML P",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $78.01 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $54.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90331",
            "Item/Package": "Item",
            "Description": "HYDRALAZINE (APRESOLINE) 20 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $78.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $55.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90342",
            "Item/Package": "Item",
            "Description": "HYDROCORTISONE (SOLU-CORTEF)/P",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $79.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $55.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91013",
            "Item/Package": "Item",
            "Description": "HYDROXYZINE HCL 50MG/ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $80.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $56.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90300",
            "Item/Package": "Item",
            "Description": "GELATIN (GELFOAM 50) 1 EACH SP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $82.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $57.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90639",
            "Item/Package": "Item",
            "Description": "SCOPOLAMINE PATCH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $83.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $58.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "327",
            "Item/Package": "Item",
            "Description": "CONRAY 50 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $84.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $59.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91027",
            "Item/Package": "Item",
            "Description": "EMPAGIFLOZIN (JARDIANCE) 25MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $86.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $60.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90678",
            "Item/Package": "Item",
            "Description": "SUCCINYLCHOLINE CHLORIDE 20 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $86.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $60.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90097",
            "Item/Package": "Item",
            "Description": "BUPIVA/EPI 1:200KPF 0.25% 30ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $90.03 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $63.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91006",
            "Item/Package": "Item",
            "Description": "GELFOAM (SURGIFOAM) 50 SPONGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $91.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $63.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90667",
            "Item/Package": "Item",
            "Description": "SODIUM CHLORIDE (MURO-128) 2%",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $93.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $65.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90104",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE/EPI/PF 30 ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $96.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $67.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90194",
            "Item/Package": "Item",
            "Description": "DIAZEPAM 10MG/2ML SYRINGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $98.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $68.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90633",
            "Item/Package": "Item",
            "Description": "RIVAROXABAN(XARELTO) 10 MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $100.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $70.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90567",
            "Item/Package": "Item",
            "Description": "PHENOL EZ SWAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $102.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $71.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90533",
            "Item/Package": "Item",
            "Description": "OFLOXACIN 0.3% OPHTH DROP 5ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $103.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $72.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90903",
            "Item/Package": "Item",
            "Description": "GELATIN (GELFOAM 100) SPONGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $108.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $75.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90243",
            "Item/Package": "Item",
            "Description": "EPINEPHRINE 1 MG/ML AMP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $109.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $76.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90992",
            "Item/Package": "Item",
            "Description": "VANCOMYCIN 1.25GM VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $111.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $77.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90061",
            "Item/Package": "Item",
            "Description": "B&O SUPP 1 EACH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $113.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $79.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90589",
            "Item/Package": "Item",
            "Description": "POTASSIUM IODIDE/IODINE 14 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $117.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $82.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90306",
            "Item/Package": "Item",
            "Description": "GENTAMICIN SULFATE 40 MG/ML VI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $120.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $84.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90135",
            "Item/Package": "Item",
            "Description": "CEFOTETAN (CEFOTAN) 2 GM/50 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $120.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $84.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90651",
            "Item/Package": "Item",
            "Description": "SITAGLIPTIN(JANUVIA) 50MG TAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $122.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $85.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90475",
            "Item/Package": "Item",
            "Description": "METHYLERGONOVINE(METHERGINE) 0",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $132.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $92.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90997",
            "Item/Package": "Item",
            "Description": "VANCOMYCIN 1.5GM VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $133.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $93.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90227",
            "Item/Package": "Item",
            "Description": "DOXYCYCLINE HYCLATE 100 MG VIA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $135.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $94.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90690",
            "Item/Package": "Item",
            "Description": "TETRACAINE (TETRAVISC) OPHTH D",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $139.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $97.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90998",
            "Item/Package": "Item",
            "Description": "SURGIFOAM SPONGE SIZE 100",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $144.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $101.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90356",
            "Item/Package": "Item",
            "Description": "HYPROMELLOSE(ISOPTO TEARS)0.5%",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $146.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $102.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90076",
            "Item/Package": "Item",
            "Description": "BARIUM SULFATE 450 ML ORAL.SUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $156.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $109.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90080",
            "Item/Package": "Item",
            "Description": "BENZOCAINE (HURRICANE) 20% 57",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $165.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $116.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90593",
            "Item/Package": "Item",
            "Description": "PREDNISOLONE ACETATE (PRED FOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $168.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $118.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90803",
            "Item/Package": "Item",
            "Description": "PHENYLEPHRINE MYDFRIN 2.5% 2ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $175.15 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $122.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90870",
            "Item/Package": "Item",
            "Description": "NITROGLYCERINE 30GM TUBE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $188.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $132.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90411",
            "Item/Package": "Item",
            "Description": "LEVOTHYROXINE SODIUM 100 MCG V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $205.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $143.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90703",
            "Item/Package": "Item",
            "Description": "TOBRA/DEX(TOBRADEX)OPHTH DROP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $243.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $170.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90781",
            "Item/Package": "Item",
            "Description": "BALANCED SALT SOL BSS 500ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $292.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $204.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90629",
            "Item/Package": "Item",
            "Description": "REMIFENTANIL(ULTIVA) 1 MG/3 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $326.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $228.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90397",
            "Item/Package": "Item",
            "Description": "KETOROLAC TROMETHAMINE(ACULAR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $327.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $229.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "516",
            "Item/Package": "Item",
            "Description": "BAL SALT SOL PLUS 500ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $332.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $232.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90329",
            "Item/Package": "Item",
            "Description": "HETASTARCH 500 ML BAG PREMIX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $345.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $241.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90244",
            "Item/Package": "Item",
            "Description": "ERTAPENEM SODIUM (INVANZ) 1 GM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $348.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $243.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90699",
            "Item/Package": "Item",
            "Description": "THROMBIN (BOVINE) 5000 UNIT V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $360.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $252.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90016",
            "Item/Package": "Item",
            "Description": "ALBUMIN HUMAN 25 GM/100 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $365.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $255.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90840",
            "Item/Package": "Item",
            "Description": "HYALURONATE SOD HEALON 10MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $377.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $264.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90363",
            "Item/Package": "Item",
            "Description": "INDOCYANINE GREEN 25 MG VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $409.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $286.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90250",
            "Item/Package": "Item",
            "Description": "ESTROGENS CONJUGATED (PREMARI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $417.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $292.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90643",
            "Item/Package": "Item",
            "Description": "SEVOFLURANE(ULTANE) 15 MINUTE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $421.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $295.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90916",
            "Item/Package": "Item",
            "Description": "ESTRADIOL 42.5GM CREAM APPL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $426.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $298.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90223",
            "Item/Package": "Item",
            "Description": "DORZOLAMIDE(TRUSOPT)OPHTH DROP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $427.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $299.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91002",
            "Item/Package": "Item",
            "Description": "GELATIN (SURGIFOAM) 1GM POWDER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $440.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $308.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90301",
            "Item/Package": "Item",
            "Description": "GELATIN (GELFOAM) 1 GM POWDER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $451.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $316.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90229",
            "Item/Package": "Item",
            "Description": "DUOVISC SOL KIT 1 EACH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $494.15 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $345.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90692",
            "Item/Package": "Item",
            "Description": "TETRACAINE HCL/PF 10 MG/ML AMP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $508.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $356.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90366",
            "Item/Package": "Item",
            "Description": "INSULIN DETEMIR 1000 UNIT/10",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $513.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $359.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90588",
            "Item/Package": "Item",
            "Description": "POT PHOS 3 MMOL/ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $515.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $360.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90239",
            "Item/Package": "Item",
            "Description": "EPINEPHRINE (ADRENALIN) 1 MG/M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $548.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $384.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90580",
            "Item/Package": "Item",
            "Description": "PNEUMOCOCCAL 23 (PNEUMOVAX) 25",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $550.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $385.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90630",
            "Item/Package": "Item",
            "Description": "REMIFENTANIL(ULTIVA) 2 MG/5 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $553.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $387.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90094",
            "Item/Package": "Item",
            "Description": "BRIMONIDINE(ALPHAGAN P)0.15% O",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $568.58 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $398.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90711",
            "Item/Package": "Item",
            "Description": "TRAVOPROST(TRAVATAN Z) .004% O",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $591.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $414.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2105",
            "Item/Package": "Item",
            "Description": "DUOVISC EYE LG .55PRO/.50VIS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $592.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $414.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90025",
            "Item/Package": "Item",
            "Description": "ALTEPLASE (CATHFLO) 2 MG VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $788.01 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $551.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91025",
            "Item/Package": "Item",
            "Description": "GEMCITABINE 1GM/5ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "J9201",
            " Charge Amount ": " $791.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $554.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90310",
            "Item/Package": "Item",
            "Description": "GLUCAGON (GLUCAGEN) 1 MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $904.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $633.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90732",
            "Item/Package": "Item",
            "Description": "VASOPRESSIN 20 UNIT/ML 1ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $937.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $656.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91026",
            "Item/Package": "Item",
            "Description": "SUGAMMADEX(BRIDION) 500MG/5ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $952.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $666.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90705",
            "Item/Package": "Item",
            "Description": "TOBRAMYCIN(TOBREX) 0.3% OPHTH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,089.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $762.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90171",
            "Item/Package": "Item",
            "Description": "COCAINE HCL 4 ML SOLUTION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,090.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $763.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90203",
            "Item/Package": "Item",
            "Description": "DIGOXIN PED 100 MCG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,128.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $789.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90702",
            "Item/Package": "Item",
            "Description": "TOBRA/DEX(TOBRADEX) 3.5 GM OPH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,169.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $818.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90698",
            "Item/Package": "Item",
            "Description": "THROMBIN (BOVINE) 20000 UNITS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,196.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $837.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90152",
            "Item/Package": "Item",
            "Description": "CIPRODEX OTIC SUSP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,268.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $887.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91003",
            "Item/Package": "Item",
            "Description": "THROMBIN (RECOTHROM) 20000U VL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,318.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $922.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90665",
            "Item/Package": "Item",
            "Description": "SODIUM BICARBONATE 1 MEQ/ML ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,514.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,059.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90241",
            "Item/Package": "Item",
            "Description": "EPINEPHRINE (EPIPEN) 0.3 MG/0.",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,526.62 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,768.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100",
            "Item/Package": "Item",
            "Description": "MISC NO CHG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5673",
            "Item/Package": "Item",
            "Description": "BAG SPONGE COUNTER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6386",
            "Item/Package": "Item",
            "Description": "GYN NOVASURE CO2 CYLINDERS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7753",
            "Item/Package": "Item",
            "Description": "RAD NEEDLE FRANSEEN BX 22GX9CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7924",
            "Item/Package": "Item",
            "Description": "RAD NEEDL FRANSEEN BX 20GX9CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7925",
            "Item/Package": "Item",
            "Description": "RAD NEEDL FRANSEEN BX 20GX15CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7926",
            "Item/Package": "Item",
            "Description": "RAD NEEDL FRANSEEN BX 22GX15CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7933",
            "Item/Package": "Item",
            "Description": "RAD CONTAINER EVAC 1000ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8012",
            "Item/Package": "Item",
            "Description": "CYSTO NEEDLE BIOPSY 18G X 10CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8152",
            "Item/Package": "Item",
            "Description": "ORT JAMSHIDI NEEDLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8343",
            "Item/Package": "Item",
            "Description": "RAD NEEDL YUEH CENTESIS CATH4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8620",
            "Item/Package": "Item",
            "Description": "GYN MYOSURE SEAL SINGLE USE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10696",
            "Item/Package": "Item",
            "Description": "RAD BOTTLE PLASTIC EVA W/DRN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10697",
            "Item/Package": "Item",
            "Description": "RAD BOTTLE PLASTIC EVACUATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11702",
            "Item/Package": "Item",
            "Description": "CATHETER TRAY ADD FOLEY (SWI)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12105",
            "Item/Package": "Item",
            "Description": "EYE KIT OPTH CUSTM TUBNG & NDL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81020",
            "Item/Package": "Item",
            "Description": "RESTER GEL SZ ULTRA HI PRO 400",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1114",
            "Item/Package": "Item",
            "Description": "SPONGE GUZE 2X2 NS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.03 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1168",
            "Item/Package": "Item",
            "Description": "BANDAGE STOCKINETTE 4 ROLL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.03 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1119",
            "Item/Package": "Item",
            "Description": "SPONGE GUZE 4X4 NS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.06 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "120",
            "Item/Package": "Item",
            "Description": "APPLICATOR Q-TIP STERILE 6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "178",
            "Item/Package": "Item",
            "Description": "BLADE TONGUE STER. 6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.16 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "862",
            "Item/Package": "Item",
            "Description": "NEEDLE HYPO 18 GA X 1 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "376",
            "Item/Package": "Item",
            "Description": "SPONGE GAUZE STERILE 2 X 2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4986",
            "Item/Package": "Item",
            "Description": "COMB BLACK 7",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5395",
            "Item/Package": "Item",
            "Description": "COVER PROBE WELCH ALLYN THERM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8810",
            "Item/Package": "Item",
            "Description": "ELECTRODE EKG Q-TRACE 5400",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "864",
            "Item/Package": "Item",
            "Description": "NEEDLE HYPO 20 GA X 1 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "866",
            "Item/Package": "Item",
            "Description": "NEEDLE HYPO 22 GA X 1 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "876",
            "Item/Package": "Item",
            "Description": "NEEDLE HYPO 27 GA X 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "871",
            "Item/Package": "Item",
            "Description": "NEEDLE HYPO 25 GA X 1 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "874",
            "Item/Package": "Item",
            "Description": "NEEDLE HYPO 25 GA X 5/8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "839",
            "Item/Package": "Item",
            "Description": "NEEDLE HYPO 27 GA X 1 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1501",
            "Item/Package": "Item",
            "Description": "SYRINGE 3 CC LL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5309",
            "Item/Package": "Item",
            "Description": "SPONGE GUAZE 4X8 NS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1079",
            "Item/Package": "Item",
            "Description": "GYN PAD OB W/ MOIST GUARD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.31 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4987",
            "Item/Package": "Item",
            "Description": "TOOTHBRUSH SOFT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.31 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3228",
            "Item/Package": "Item",
            "Description": "LUBRICANT JELLY 3 GR PACK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1497",
            "Item/Package": "Item",
            "Description": "SYRINGE 1 CC TB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1500",
            "Item/Package": "Item",
            "Description": "SYRINGE 3 CC 20 GA X 1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.37 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "381",
            "Item/Package": "Item",
            "Description": "DRESSING TELFA 2 X 3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "155",
            "Item/Package": "Item",
            "Description": "BASIN EMESIS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4984",
            "Item/Package": "Item",
            "Description": "TABLET DENTURE CLEANSER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5865",
            "Item/Package": "Item",
            "Description": "GYN PAD OB W / AHDHESIVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1505",
            "Item/Package": "Item",
            "Description": "SYRINGE 5 CC LL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "844",
            "Item/Package": "Item",
            "Description": "NEEDLE HYPO 30 GA X 1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2532",
            "Item/Package": "Item",
            "Description": "NEEDLE HYPO 30 GA X 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6997",
            "Item/Package": "Item",
            "Description": "NEEDLE HYPO 18GA X1 1/2  BLT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "395",
            "Item/Package": "Item",
            "Description": "DRESSING ABD 5 X 9",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1495",
            "Item/Package": "Item",
            "Description": "PAIN SYRINGE 10CC LL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1496",
            "Item/Package": "Item",
            "Description": "SYRINGE 1 CC INSULIN 26GX1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "836",
            "Item/Package": "Item",
            "Description": "NEEDLE HYPO 25 GA X 2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3308",
            "Item/Package": "Item",
            "Description": "SPONGE GAUZE STERILE 4 X 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3298",
            "Item/Package": "Item",
            "Description": "LANCET SAFETY ORANGE 2.2MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2017",
            "Item/Package": "Item",
            "Description": "ELECTRODE MONITORING RED DOT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "325",
            "Item/Package": "Item",
            "Description": "CUP DENTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.58 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1498",
            "Item/Package": "Item",
            "Description": "SYRINGE 1 CC TB 25GX5/8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2571",
            "Item/Package": "Item",
            "Description": "CYSTO FILTER STONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2824",
            "Item/Package": "Item",
            "Description": "PREP SKIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "597",
            "Item/Package": "Item",
            "Description": "EYE PAD OVAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2203",
            "Item/Package": "Item",
            "Description": "SYRINGE 10 CC SLIP TIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3265",
            "Item/Package": "Item",
            "Description": "DRESSING TELFA 3 X 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2178",
            "Item/Package": "Item",
            "Description": "CONTAINER SPECIMEN 4 OZ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1504",
            "Item/Package": "Item",
            "Description": "SYRINGE 5 CC 20 GA X 1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1158",
            "Item/Package": "Item",
            "Description": "SPONGE LAP 4 X 18",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1195",
            "Item/Package": "Item",
            "Description": "GYN SWAB PROCTO 16",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2840",
            "Item/Package": "Item",
            "Description": "DRESSING TELFA MINI ISLAND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "236",
            "Item/Package": "Item",
            "Description": "CAST PLASTER SPLNT 3X15",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "308",
            "Item/Package": "Item",
            "Description": "CHUX UNDERPAD 23 X 36",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4981",
            "Item/Package": "Item",
            "Description": "SPONGE GAUZE STERILE 4X4 DRAIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4982",
            "Item/Package": "Item",
            "Description": "TOOTHETTE SWAB ORAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10595",
            "Item/Package": "Item",
            "Description": "NEEDLE MONJET LNG HUB 25G",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5811",
            "Item/Package": "Item",
            "Description": "RESP ADAPTER AEROSOL TEE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "234",
            "Item/Package": "Item",
            "Description": "CAST PLASTER SPLNT 4X15",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $0.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8457",
            "Item/Package": "Item",
            "Description": "NEEDLE HYPO SFTY 22 GA X 1 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.01 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4988",
            "Item/Package": "Item",
            "Description": "TOOTHPASTE FLUORIDE 2.75 OZ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "842",
            "Item/Package": "Item",
            "Description": "NEEDLE HYPO 19 GA FILTER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1499",
            "Item/Package": "Item",
            "Description": "SYRINGE 20 CC LL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8454",
            "Item/Package": "Item",
            "Description": "NEEDLE HYPO SFTY 22 GA X 1 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8459",
            "Item/Package": "Item",
            "Description": "NEEDLE HYPO SFTY 27 GA X 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.31 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3102",
            "Item/Package": "Item",
            "Description": "CONTAINER SPECIMEN 4 OZ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3553",
            "Item/Package": "Item",
            "Description": "MARKER SKIN NON-STERILE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3519",
            "Item/Package": "Item",
            "Description": "PREP IODINE SWABSTICKS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "300",
            "Item/Package": "Item",
            "Description": "CAUTERY TIP CLEANER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2921",
            "Item/Package": "Item",
            "Description": "GRADUATE CLEAR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3930",
            "Item/Package": "Item",
            "Description": "SPECI PAN WHITE 1200 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7125",
            "Item/Package": "Item",
            "Description": "ENDO HEMORRHOID RUBBERBAND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2821",
            "Item/Package": "Item",
            "Description": "DEXTROSE 5% IN WATER 500ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9425",
            "Item/Package": "Item",
            "Description": "ADAPTER CHRISTMAS TREE GRN O2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8786",
            "Item/Package": "Item",
            "Description": "MOUTHWASH ALCOHOL FREE 2OZ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8851",
            "Item/Package": "Item",
            "Description": "SYRINGE 1CC INSULIN U100LL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "191",
            "Item/Package": "Item",
            "Description": "RESP CANNULA NASAL W/7' TUBE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "372",
            "Item/Package": "Item",
            "Description": "DRESSING ADAPTIC 3 X 3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "600",
            "Item/Package": "Item",
            "Description": "EYE SPEARS ULTRACEL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "169",
            "Item/Package": "Item",
            "Description": "BLADE SCALPEL SURGICAL 12",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "239",
            "Item/Package": "Item",
            "Description": "CAST PLASTER SPLNT FAST 5X30",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "165",
            "Item/Package": "Item",
            "Description": "BLADE SCALPEL SURGICAL 10",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "167",
            "Item/Package": "Item",
            "Description": "BLADE SCALPEL SURGICAL 11",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "171",
            "Item/Package": "Item",
            "Description": "BLADE SCALPEL SURGICAL 15",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3578",
            "Item/Package": "Item",
            "Description": "FILM SONY MINI C-ARM 130 PR RO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2776",
            "Item/Package": "Item",
            "Description": "RESP ADAPTER HUMIDIFIER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.94 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2778",
            "Item/Package": "Item",
            "Description": "RESP TUBING O2 CONNECTING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.94 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "618",
            "Item/Package": "Item",
            "Description": "AIRWAY GUEDEL 90MM COLOR CODE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "607",
            "Item/Package": "Item",
            "Description": "AIRWAY GUEDEL 100MM COLOR CODE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "126",
            "Item/Package": "Item",
            "Description": "BANDAGE SOFT KLING 2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10856",
            "Item/Package": "Item",
            "Description": "RAZOR STER DBLSIDE SHAVE PREP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2554",
            "Item/Package": "Item",
            "Description": "SYRINGE 10 CC SAFETY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.01 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2839",
            "Item/Package": "Item",
            "Description": "CYSTO CATH PLUG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11545",
            "Item/Package": "Item",
            "Description": "DEODORANT/ANTIPRSPIRANT ROLLON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.06 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10475",
            "Item/Package": "Item",
            "Description": "SYRINGE 10CC SFTY W/NDLE 21G",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "268",
            "Item/Package": "Item",
            "Description": "CATHETER RED RUBBER 14FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "270",
            "Item/Package": "Item",
            "Description": "CATHETER RED RUBBER 16FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1507",
            "Item/Package": "Item",
            "Description": "SYRINGE 50 CC LL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2024",
            "Item/Package": "Item",
            "Description": "CATHETER RED RUBBER 12FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2070",
            "Item/Package": "Item",
            "Description": "CATHETER RED RUBBER 10FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "641",
            "Item/Package": "Item",
            "Description": "CATHETER SUCT WHISTLE TIP 18FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1508",
            "Item/Package": "Item",
            "Description": "ENDO SYRINGE SLIP TIP 60CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "385",
            "Item/Package": "Item",
            "Description": "DRESSING TEGADERM 2 3/8X2 3/4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "132",
            "Item/Package": "Item",
            "Description": "BANDAGE ACE 2  VELCRO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "158",
            "Item/Package": "Item",
            "Description": "BENZOIN TINC SWAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "150",
            "Item/Package": "Item",
            "Description": "BANDAGE SOFT KLING 3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3433",
            "Item/Package": "Item",
            "Description": "SUCTION TIP YANKAUER REG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1569",
            "Item/Package": "Item",
            "Description": "URINAL MALE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9073",
            "Item/Package": "Item",
            "Description": "DAVINCI ENDWRST STPLR CABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "716",
            "Item/Package": "Item",
            "Description": "ENDO GOWN ISOLATION YELLOW",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "333",
            "Item/Package": "Item",
            "Description": "UNDERWEAR XTRA PROTECTIVE LRG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "127",
            "Item/Package": "Item",
            "Description": "BANDAGE SOFT KLING 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8571",
            "Item/Package": "Item",
            "Description": "WASHBASIN RECTANGULAR 8 QT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "370",
            "Item/Package": "Item",
            "Description": "SPONGE GAUZE STERILE TRAY 4X4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "133",
            "Item/Package": "Item",
            "Description": "BANDAGE ACE 3  VELCRO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9153",
            "Item/Package": "Item",
            "Description": "GOWN PATIENT DISP BLU REG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6854",
            "Item/Package": "Item",
            "Description": "SYRINGE 10 CC TWIN PAK COMBO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.01 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "156",
            "Item/Package": "Item",
            "Description": "BEDPAN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6430",
            "Item/Package": "Item",
            "Description": "RESP SUCTION KIT 10 FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7002",
            "Item/Package": "Item",
            "Description": "CATHETER SUCT SAFE-T VAC 14FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5442",
            "Item/Package": "Item",
            "Description": "SUCTION TIP YANKAUER FLEX REG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11625",
            "Item/Package": "Item",
            "Description": "DRAPE UTILITY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "811",
            "Item/Package": "Item",
            "Description": "MARKER SKIN W/ LABELS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10952",
            "Item/Package": "Item",
            "Description": "UNDERWEAR XTRA PROTECTIVE XLG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2046",
            "Item/Package": "Item",
            "Description": "CAST PLASTER SPLNT FAST 5X45",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "397",
            "Item/Package": "Item",
            "Description": "SYRINGE EAR 2 OZ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "390",
            "Item/Package": "Item",
            "Description": "DRESSING XEROFORM 1 X 8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5364",
            "Item/Package": "Item",
            "Description": "IRRIGATION DECANTER BAG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7242",
            "Item/Package": "Item",
            "Description": "TOWEL WH STERL X-RAY DETECTBL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3679",
            "Item/Package": "Item",
            "Description": "SUCTION TIP POOLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "142",
            "Item/Package": "Item",
            "Description": "CLOSURE STERI-STRIP 1/4X3 BRN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4908",
            "Item/Package": "Item",
            "Description": "CREAM UDDER TUBE 2 OZ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5392",
            "Item/Package": "Item",
            "Description": "OSTOMY CLAMP DRAINABLE POUCH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "705",
            "Item/Package": "Item",
            "Description": "GLOVE SUR LATEX   6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "706",
            "Item/Package": "Item",
            "Description": "GLOVE SUR LATEX   6 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "708",
            "Item/Package": "Item",
            "Description": "GLOVE SUR LATEX   7",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "709",
            "Item/Package": "Item",
            "Description": "GLOVE SUR LATEX   7 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710",
            "Item/Package": "Item",
            "Description": "GLOVE SUR LATEX   8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711",
            "Item/Package": "Item",
            "Description": "GLOVE SUR LATEX   8 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5912",
            "Item/Package": "Item",
            "Description": "GLOVE SUR LATEX   9",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2807",
            "Item/Package": "Item",
            "Description": "SLIPPERS SMALL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8001",
            "Item/Package": "Item",
            "Description": "OSTOMY POUCH 2 3/4 DRAINABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "148",
            "Item/Package": "Item",
            "Description": "BANDAGE KERLIX 4 1/2  X 4.1 YD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2240",
            "Item/Package": "Item",
            "Description": "CAST PADDING STERILE 2 WEBRIL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3180",
            "Item/Package": "Item",
            "Description": "BANDAGE ACE 4''  VELCRO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "151",
            "Item/Package": "Item",
            "Description": "CLOSURE STERI-STRIP 1/4X3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5023",
            "Item/Package": "Item",
            "Description": "LAB ISTAT CHEM 8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11351",
            "Item/Package": "Item",
            "Description": "SLIPPERS XXLRG BLUE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.02 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2065",
            "Item/Package": "Item",
            "Description": "SLIPPERS XLRG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "363",
            "Item/Package": "Item",
            "Description": "DRAIN PENROSE STR 1/4 X 12",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1510",
            "Item/Package": "Item",
            "Description": "SYRINGE BULB 60 CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "153",
            "Item/Package": "Item",
            "Description": "CLOSURE STERI-STRIP 1/8X3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "392",
            "Item/Package": "Item",
            "Description": "DRESSING XEROFORM 5 X 9",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10139",
            "Item/Package": "Item",
            "Description": "NEEDLE SAFETY BLOOD COL23X3/4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3539",
            "Item/Package": "Item",
            "Description": "SUCTION TUBING 3/16X6 NONSTRL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5664",
            "Item/Package": "Item",
            "Description": "DRAPE STERI SMALL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1164",
            "Item/Package": "Item",
            "Description": "SPONGE GAUZE RAYTEC 4 X 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2993",
            "Item/Package": "Item",
            "Description": "BEDPAN FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "228",
            "Item/Package": "Item",
            "Description": "CAST PLASTER X FAST 2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "841",
            "Item/Package": "Item",
            "Description": "NEEDLE COUNTER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10311",
            "Item/Package": "Item",
            "Description": "SLEEVE STERILE DISPOSABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "825",
            "Item/Package": "Item",
            "Description": "RESP MASK O2 MEDCON W/TUBE PED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6390",
            "Item/Package": "Item",
            "Description": "ENDO SUCTION SIGMOID 18FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1196",
            "Item/Package": "Item",
            "Description": "SYRINGE 10 CC CONTROL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8963",
            "Item/Package": "Item",
            "Description": "WIPE FLUSHABLE COTTONLLE MOIST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11352",
            "Item/Package": "Item",
            "Description": "SLIPPERS BARIATRIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6915",
            "Item/Package": "Item",
            "Description": "OSTOMY POUCH 4'' DRAINABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1550",
            "Item/Package": "Item",
            "Description": "SUCTION TUBING CONN 1/4X10",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1923",
            "Item/Package": "Item",
            "Description": "DRESSING TEGADERM 4 X 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1088",
            "Item/Package": "Item",
            "Description": "LAB TEST PREGNANCY URINE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1760",
            "Item/Package": "Item",
            "Description": "GYN PANTY MATERNITY XXL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5399",
            "Item/Package": "Item",
            "Description": "GLOVE SUR ENCORE   8 PF",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5848",
            "Item/Package": "Item",
            "Description": "GLOVE SUR ENCORE   8 1/2 PF",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5909",
            "Item/Package": "Item",
            "Description": "GLOVE SUR ENCORE   9 PF",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9375",
            "Item/Package": "Item",
            "Description": "GLOVE SUR ENCORE 7 1/2 PF",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9582",
            "Item/Package": "Item",
            "Description": "DRAIN PENROSE STR 1/2X12",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10688",
            "Item/Package": "Item",
            "Description": "GLOVE SUR ENCORE 6 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "604",
            "Item/Package": "Item",
            "Description": "EYE SHIELD UNIVERSAL EYE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3136",
            "Item/Package": "Item",
            "Description": "ENDO BITE BLOCK INTERMED 48FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1002",
            "Item/Package": "Item",
            "Description": "ORT PIN BALL JURGAN 0.54 GREEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3344",
            "Item/Package": "Item",
            "Description": "GLOVE SUR BIOGEL SENSOR 71/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "579",
            "Item/Package": "Item",
            "Description": "TUBING IV SECONDARY 15 GTTS/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.23 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7577",
            "Item/Package": "Item",
            "Description": "LAB TEST STRIP GLUCOSE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7991",
            "Item/Package": "Item",
            "Description": "BANDAGE COBAN 2' LATEX FREE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206",
            "Item/Package": "Item",
            "Description": "CAST PADDING DELTA ROLL 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2119",
            "Item/Package": "Item",
            "Description": "DRAPE MAYO COVER W/PAD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2774",
            "Item/Package": "Item",
            "Description": "RESP MASK NON-REBREATHW/TUBING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3412",
            "Item/Package": "Item",
            "Description": "ICE BAG SMALL 5X12 CARDINAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "368",
            "Item/Package": "Item",
            "Description": "DRESSING ADAPTIC 3 X 8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "371",
            "Item/Package": "Item",
            "Description": "SUTURE SILK 0 STRANDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3875",
            "Item/Package": "Item",
            "Description": "ICE BAG LARGE 6.5X14 CARDINAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "230",
            "Item/Package": "Item",
            "Description": "CAST PLASTER X FAST 3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3181",
            "Item/Package": "Item",
            "Description": "BANDAGE ACE 6''  VELCRO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7305",
            "Item/Package": "Item",
            "Description": "PAIN EXTENSION SET STD BORE 30",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.62 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2782",
            "Item/Package": "Item",
            "Description": "RESP NEBULIZER MICRO MIST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1188",
            "Item/Package": "Item",
            "Description": "SUCTION TIP FRAZIER 12 FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3198",
            "Item/Package": "Item",
            "Description": "BLADE SCALPEL PROTECTED 11",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "220",
            "Item/Package": "Item",
            "Description": "CAST PADDING STERILE 3 WEBRIL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3199",
            "Item/Package": "Item",
            "Description": "BLADE SCALPEL PROTECTED 15",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4983",
            "Item/Package": "Item",
            "Description": "REMOVER SUTURE TRAY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "660",
            "Item/Package": "Item",
            "Description": "GLOVE SUR BIOGEL   6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "662",
            "Item/Package": "Item",
            "Description": "GLOVE SUR BIOGEL   7 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "698",
            "Item/Package": "Item",
            "Description": "GLOVE SUR BIOGEL   7",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "699",
            "Item/Package": "Item",
            "Description": "GLOVE SUR BIOGEL   8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2230",
            "Item/Package": "Item",
            "Description": "GLOVE SUR BIOGEL   8 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2682",
            "Item/Package": "Item",
            "Description": "GLOVE SUR BIOGEL   6 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2898",
            "Item/Package": "Item",
            "Description": "CATHETER RED RUBBER 20FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2860",
            "Item/Package": "Item",
            "Description": "STERILE SPECIMEN CUP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3197",
            "Item/Package": "Item",
            "Description": "BLADE SCALPEL PROTECTED 10",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1675",
            "Item/Package": "Item",
            "Description": "DRAIN PENROSE STR 3/8 X 12",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1580",
            "Item/Package": "Item",
            "Description": "CYSTO BAG LEG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.03 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3462",
            "Item/Package": "Item",
            "Description": "DRAPE C-ARM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "144",
            "Item/Package": "Item",
            "Description": "CLOSURE STERI-STRIP 1/2X4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.06 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3048",
            "Item/Package": "Item",
            "Description": "CYSTO CATH ADAPTOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "431",
            "Item/Package": "Item",
            "Description": "INSTRUMENT WIPE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8107",
            "Item/Package": "Item",
            "Description": "RAD COVER ECLIPSE PROBE US",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "212",
            "Item/Package": "Item",
            "Description": "CAST PADDING NONSTERILE 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.40 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5451",
            "Item/Package": "Item",
            "Description": "KIT CLEAN CATCH W/SOAP TOWELLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2838",
            "Item/Package": "Item",
            "Description": "CYSTO CATH STRAP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1547",
            "Item/Package": "Item",
            "Description": "ORT TUBING SUCTION 9/32X12",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1539",
            "Item/Package": "Item",
            "Description": "ENDO TRAP SPECIMEN 40CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3063",
            "Item/Package": "Item",
            "Description": "TUBING IV MICROBORE EXTEN SET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "535",
            "Item/Package": "Item",
            "Description": "DEXTROSE 5% IN WATER 1000ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.93 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8002",
            "Item/Package": "Item",
            "Description": "OSTOMY FLANGE 2 3/4 COLOSTOMY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1150",
            "Item/Package": "Item",
            "Description": "ORT SPIRAL BLADE TITANIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "547",
            "Item/Package": "Item",
            "Description": "SOD CHLORIDE 0.9% 1000ML BAG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3576",
            "Item/Package": "Item",
            "Description": "ANGIOCATH JELCO 14G X 2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "373",
            "Item/Package": "Item",
            "Description": "SUTURE SILK 2-0 SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.40 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "380",
            "Item/Package": "Item",
            "Description": "SUTURE SILK 3-0 SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "475",
            "Item/Package": "Item",
            "Description": "DRAPE STERI SM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1155",
            "Item/Package": "Item",
            "Description": "SPONGE LAP 18 X 18",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.45 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "118",
            "Item/Package": "Item",
            "Description": "LAP ANTIFOG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "742",
            "Item/Package": "Item",
            "Description": "LUBRICANT JELLY TUBE 4OZ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5003",
            "Item/Package": "Item",
            "Description": "SOD CHLORIDE 0.9% 250ML BAG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5453",
            "Item/Package": "Item",
            "Description": "SUTURE SILK 0 BLK CT-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3971",
            "Item/Package": "Item",
            "Description": "DRAPE STERI INSTRUMENT POUCH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "472",
            "Item/Package": "Item",
            "Description": "SUTURE TAPE UMBILICAL COTTON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.62 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5758",
            "Item/Package": "Item",
            "Description": "IRRIGATION TRAY PISTON SYR 60",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7503",
            "Item/Package": "Item",
            "Description": "GYN VACURETTE CVD 10 MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "181",
            "Item/Package": "Item",
            "Description": "SUCTION CANISTER LINER 1500CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.71 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "542",
            "Item/Package": "Item",
            "Description": "SOD CHLORIDE 0.9% 100ML BAG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11728",
            "Item/Package": "Item",
            "Description": "ENDO INTRCPT BEDSIDE SPONGE KT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2373",
            "Item/Package": "Item",
            "Description": "PAIN EXTENSION SET MINIBORE 7",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "393",
            "Item/Package": "Item",
            "Description": "SUTURE SILK 4-0 SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2780",
            "Item/Package": "Item",
            "Description": "RESP AQUAPAK STER WATER 440ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10026",
            "Item/Package": "Item",
            "Description": "GLOVE GAMMEX CHEMO LF/PF 6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10027",
            "Item/Package": "Item",
            "Description": "GLOVE GAMMEX CHEMO LF/PF 7",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1596",
            "Item/Package": "Item",
            "Description": "GYN VACURETTE CVD 7 MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1597",
            "Item/Package": "Item",
            "Description": "GYN VACURETTE STR 8 MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "311",
            "Item/Package": "Item",
            "Description": "ORT SMARTNAIL 1.5MM X 25MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "231",
            "Item/Package": "Item",
            "Description": "CAST PLASTER X FAST 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "821",
            "Item/Package": "Item",
            "Description": "RESP MASK O2 MEDCON W/TUBE ADT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6416",
            "Item/Package": "Item",
            "Description": "GYN VACURETTE CVD 8 MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2959",
            "Item/Package": "Item",
            "Description": "BAG URINE DRAINAGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "550",
            "Item/Package": "Item",
            "Description": "SOD CHLORIDE 0.9% 500ML BAG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7868",
            "Item/Package": "Item",
            "Description": "ENDO ENDOGTOR CONN AUX W/ PORT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "375",
            "Item/Package": "Item",
            "Description": "SUTURE SILK 2-0 STRANDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6659",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 30 FR 30 CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "445",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 2-0 SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3942",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 2-0 CT-1 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3947",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 2-0 UND BR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "449",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 3-0 SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7554",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 3-0 UND SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5810",
            "Item/Package": "Item",
            "Description": "RESP AQUAPAK STER WATER W/ADP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "500",
            "Item/Package": "Item",
            "Description": "DRAPE FANFOLD 40 X 70",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2768",
            "Item/Package": "Item",
            "Description": "PAIN NEEDLE SPINAL 25G X 3 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "462",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 0 CT-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8227",
            "Item/Package": "Item",
            "Description": "RAD COVER X-RAY CASS 14X17",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "421",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 3-0 CT-2 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "461",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 1 CT-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.13 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3945",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 1 CT-1 27 UND BR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.13 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "442",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 0 CT-2 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11125",
            "Item/Package": "Item",
            "Description": "SUT VICRYL 1 CTX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4043",
            "Item/Package": "Item",
            "Description": "SUTURE SURGILON 1 T-12/GS21",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3944",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 0 CT-1 UND BR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "145",
            "Item/Package": "Item",
            "Description": "BANDAGE ESMARK 4 X 9",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "419",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 2-0 CT-2 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3941",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 0 CT-1 BR VIL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3112",
            "Item/Package": "Item",
            "Description": "CYSTO SYRINGE TOOMEY 70",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11126",
            "Item/Package": "Item",
            "Description": "SUT VICRYL 2/0 CT-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6737",
            "Item/Package": "Item",
            "Description": "DRESSING TEGADERM 6 X 8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "184",
            "Item/Package": "Item",
            "Description": "SUCTION CANISTER LINER 3000CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6535",
            "Item/Package": "Item",
            "Description": "GLOVE SUR BIOGEL LATEX FR 81/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3555",
            "Item/Package": "Item",
            "Description": "GLOVE SUR BIOGEL LATEX FR  61/",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5454",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 0 BR VIL CP-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1110",
            "Item/Package": "Item",
            "Description": "PREP IODINE SCRUB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3554",
            "Item/Package": "Item",
            "Description": "GLOVE SUR BIOGEL LATEX FR 6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "569",
            "Item/Package": "Item",
            "Description": "IRRIGATION STER WATER 1000CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3556",
            "Item/Package": "Item",
            "Description": "GLOVE SUR BIOGEL LATEX FR 7",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3948",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 1 CT-1 UND BR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "387",
            "Item/Package": "Item",
            "Description": "SUTURE SILK 3-0 X-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3557",
            "Item/Package": "Item",
            "Description": "GLOVE SUR BIOGEL LATEX FR 71/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3558",
            "Item/Package": "Item",
            "Description": "GLOVE SUR BIOGEL LATEX FR 8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "240",
            "Item/Package": "Item",
            "Description": "SUTURE ETHIBOND 0 CT-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6538",
            "Item/Package": "Item",
            "Description": "GLOVE SUR BIOGEL LATEX FR 9",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7944",
            "Item/Package": "Item",
            "Description": "CAP HAIR SHAMPOO CARE COMFORT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "141",
            "Item/Package": "Item",
            "Description": "DRESSING STRATASORB 4 X 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "533",
            "Item/Package": "Item",
            "Description": "DEXTROSE 5%-0.45% NACL 1000ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $9.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3113",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 3-0 SH-1 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "457",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 4-0 SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5061",
            "Item/Package": "Item",
            "Description": "ADAPTER PRN MAX PLUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "526",
            "Item/Package": "Item",
            "Description": "DEXTROSE 5%-LACT RNG 1000ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "214",
            "Item/Package": "Item",
            "Description": "CAST PADDING NONSTERILE 6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2779",
            "Item/Package": "Item",
            "Description": "RESP MASK VENTIMASK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.37 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "382",
            "Item/Package": "Item",
            "Description": "SUTURE SILK 3-0 STRANDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "551",
            "Item/Package": "Item",
            "Description": "IRRIGATION NACL 0.9% 1000CC BT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5090",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 0 UND BR SH 27",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6540",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 4-0 RB-1 PLUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "454",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 4-0 RB-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6046",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 3-0 CT-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10508",
            "Item/Package": "Item",
            "Description": "EYE CANNULA ANT CHMBR INJ 27G",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "633",
            "Item/Package": "Item",
            "Description": "ANGIOCATH 18G X 1 1/4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "635",
            "Item/Package": "Item",
            "Description": "ANGIOCATH 22G X 1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1728",
            "Item/Package": "Item",
            "Description": "ANGIOCATH 24G X 3/4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2953",
            "Item/Package": "Item",
            "Description": "ANGIOCATH 20G X 1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2905",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 0 UR-6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6348",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 2-0 CP-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.94 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "448",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 2-0 UR-6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4980",
            "Item/Package": "Item",
            "Description": "CLEANSER WOUND W/ZINC 4OZ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2158",
            "Item/Package": "Item",
            "Description": "CAUTERY PAD ADULT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6924",
            "Item/Package": "Item",
            "Description": "ENDO BITE BLOCK MAXI 60FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10321",
            "Item/Package": "Item",
            "Description": "SUT VICRYL 3-0 R-1 PLUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "232",
            "Item/Package": "Item",
            "Description": "CAST PLASTER X FAST 6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "137",
            "Item/Package": "Item",
            "Description": "CLOSURE STERI-STRIP 1X5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5070",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 1 CT-1 36",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.58 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1098",
            "Item/Package": "Item",
            "Description": "PREP BETADINE SOL'N STICKS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3637",
            "Item/Package": "Item",
            "Description": "BANDAGE COBAN 4' LATEX FREE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10332",
            "Item/Package": "Item",
            "Description": "TELFA PLUS 4X6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2667",
            "Item/Package": "Item",
            "Description": "IRRIGATION WATER 1000 CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11623",
            "Item/Package": "Item",
            "Description": "PAIN NEEDLE SPINAL 25Gx31/2 BD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "407",
            "Item/Package": "Item",
            "Description": "BLADE BEAVER 64 ROUND TIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "409",
            "Item/Package": "Item",
            "Description": "BLADE BEAVER 67 CURVED TIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "650",
            "Item/Package": "Item",
            "Description": "HEAD CRADLE FOAM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "435",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 4-0 STRANDS UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11.94 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "246",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 3-0 KS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7432",
            "Item/Package": "Item",
            "Description": "DRAPE U-DRAPE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.06 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "484",
            "Item/Package": "Item",
            "Description": "DRAPE STERI MED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "394",
            "Item/Package": "Item",
            "Description": "SUTURE SILK 4-0 STRANDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "463",
            "Item/Package": "Item",
            "Description": "SUTURE ETHIBOND 2-0 SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "447",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 2-0 STRANDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "222",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 2-0 FSL UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3468",
            "Item/Package": "Item",
            "Description": "CANNULA NASAL MAC SAFE W/ SAMP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10201",
            "Item/Package": "Item",
            "Description": "PREP POV/IODINE SOLUTION 8OZ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5517",
            "Item/Package": "Item",
            "Description": "SUTURE MONOCRYL 3-0 SH VIL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5518",
            "Item/Package": "Item",
            "Description": "SUTURE MONOCRYL 3-0 SH U/D",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11366",
            "Item/Package": "Item",
            "Description": "CLIPPER BLADE SENSICLIP SURG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2450",
            "Item/Package": "Item",
            "Description": "CAST TAPE DELTA WHITE 2X4YDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6738",
            "Item/Package": "Item",
            "Description": "DRESSING MEDIPORE PRE CUT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "219",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 2-0 FS-1 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5104",
            "Item/Package": "Item",
            "Description": "CLIPPER BLADE SURGICAL CARD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "739",
            "Item/Package": "Item",
            "Description": "STYLETTE  INTUBATING 10 FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5304",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL PLUS CP-1 VIL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5516",
            "Item/Package": "Item",
            "Description": "SUTURE MONOCRYL 4-0 UND RB-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2200",
            "Item/Package": "Item",
            "Description": "EYE LIGHT SHIELD CORNEAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.15 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3950",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 2-0 UND BR 3-18",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12076",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE XXL LONG 552",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12078",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE XXXL REG 561",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1613",
            "Item/Package": "Item",
            "Description": "PACKING IODOFORM 1/4 X 5YDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.45 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1153",
            "Item/Package": "Item",
            "Description": "SPONGE K DISSECTOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "849",
            "Item/Package": "Item",
            "Description": "NEEDLE SPINAL 18 GA X 3 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "485",
            "Item/Package": "Item",
            "Description": "DRAPE LASER ARM 7 X 55",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "146",
            "Item/Package": "Item",
            "Description": "BANDAGE ESMARK 6 X 12",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3413",
            "Item/Package": "Item",
            "Description": "PAD HEEL ELBOW ULNAR NERVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6883",
            "Item/Package": "Item",
            "Description": "SUCTION HOSE CONNECTOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3940",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 3-0 UND BR 3-18",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2016",
            "Item/Package": "Item",
            "Description": "LOOP VESSEL MAXI RED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2616",
            "Item/Package": "Item",
            "Description": "SUTURE ETHIBOND 2 0S-4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $13.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9871",
            "Item/Package": "Item",
            "Description": "SUT VICRYL 1 OS-6 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.01 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9493",
            "Item/Package": "Item",
            "Description": "TOWEL BLUE STERILE XRAY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12074",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE XXLG SHRT550",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12069",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE SM LONG 512",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12070",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE MED SHRT 520",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12071",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE LG SHRT 530",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12072",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE LG LONG 532",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12073",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE XLG SHRT 540",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12075",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE XXLG REG 551",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8923",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE XLG LONG 542",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.23 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "451",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 3-0 STRANDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2131",
            "Item/Package": "Item",
            "Description": "PREP DRY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "889",
            "Item/Package": "Item",
            "Description": "PAIN NEEDLE SPINAL 22G X 3 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3936",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE MED LONG 522",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8286",
            "Item/Package": "Item",
            "Description": "NEEDLE SPINAL SGL 22GX 2 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "238",
            "Item/Package": "Item",
            "Description": "SUTURE ETHIBOND 1 0S-4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "243",
            "Item/Package": "Item",
            "Description": "SUTURE ETHIBOND 1 0S-6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8553",
            "Item/Package": "Item",
            "Description": "RESP HEAT MOIST EXCHANG W/TUBE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6660",
            "Item/Package": "Item",
            "Description": "FILM STRYKER COLOR DIGITAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.62 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3932",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE SM REG 511",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12079",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE XXXL LONG562",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3933",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE MED REG 521",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2172",
            "Item/Package": "Item",
            "Description": "SUTURE PDS II 0 CT-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "934",
            "Item/Package": "Item",
            "Description": "ORT INTERPULSE LAVAGE DEVICE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $14.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "343",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 1 CT-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "983",
            "Item/Package": "Item",
            "Description": "ORT K-WIRE .035 X 6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "985",
            "Item/Package": "Item",
            "Description": "ORT K-WIRE .045 X 6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "986",
            "Item/Package": "Item",
            "Description": "ORT K-WIRE .045 X160MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2219",
            "Item/Package": "Item",
            "Description": "ORT K-WIRE 9\" .062",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2464",
            "Item/Package": "Item",
            "Description": "SUTURE PDS II 2-0 SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.13 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5627",
            "Item/Package": "Item",
            "Description": "PUNCH BIOPSY 4MM DISP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.13 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1066",
            "Item/Package": "Item",
            "Description": "PACKING PLAIN 1/4 X 5YDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3935",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE XL REG 541",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8552",
            "Item/Package": "Item",
            "Description": "RESP CIRCUIT VENT ESPRIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7197",
            "Item/Package": "Item",
            "Description": "DRAPE INSTRUMENT POUCH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "541",
            "Item/Package": "Item",
            "Description": "LACTATED RINGERS 500ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "340",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 0 CT-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "478",
            "Item/Package": "Item",
            "Description": "DRAPE STERI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "496",
            "Item/Package": "Item",
            "Description": "PACK SET UP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3931",
            "Item/Package": "Item",
            "Description": "RESP SPIROMETER INCENTIVE 5000",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2453",
            "Item/Package": "Item",
            "Description": "PREP DURA SMALL 6ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3934",
            "Item/Package": "Item",
            "Description": "STOCKING TED KNEE LG REG 531",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.62 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5443",
            "Item/Package": "Item",
            "Description": "PROTECTOR FOAM FOOT AND ELBOW",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5738",
            "Item/Package": "Item",
            "Description": "SUTURE SILK 5-0 BLK BR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.71 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5129",
            "Item/Package": "Item",
            "Description": "REMOVER SKIN STAPLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7425",
            "Item/Package": "Item",
            "Description": "DRAPE C-ARM SUPER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "336",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 2-0 FS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10296",
            "Item/Package": "Item",
            "Description": "TUBE SALEM SUMP 14FR STERILE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $15.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1173",
            "Item/Package": "Item",
            "Description": "ORT TJ STEM TAPERED POROCOAT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.03 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2435",
            "Item/Package": "Item",
            "Description": "SUTURE PDS II 0 CT-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.03 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5314",
            "Item/Package": "Item",
            "Description": "DRAPE FANFOLD 53 X 77 REINFCD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.03 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "527",
            "Item/Package": "Item",
            "Description": "ENT SPONGE TONSIL ROUND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.06 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3951",
            "Item/Package": "Item",
            "Description": "SUTURE PDS II 0 CT-1 VIL MONO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7583",
            "Item/Package": "Item",
            "Description": "ENDO POLYP TRAP SINGLE CHAMBER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5557",
            "Item/Package": "Item",
            "Description": "SUTURE MONOCRYL 5-0 PLUS RB-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5692",
            "Item/Package": "Item",
            "Description": "PAIN NEEDLE SPINAL 25G X 2 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1059",
            "Item/Package": "Item",
            "Description": "PACKING IODOFORM 1X 5YRDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "508",
            "Item/Package": "Item",
            "Description": "SHEET UNDER BUTTOCKS W/POUCH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6428",
            "Item/Package": "Item",
            "Description": "SPINE COLLAR UNIVERSAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.45 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "522",
            "Item/Package": "Item",
            "Description": "TUBING EXTEN SET W/2 INJ SITES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6435",
            "Item/Package": "Item",
            "Description": "FILTER BACTERIA BIPAP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2442",
            "Item/Package": "Item",
            "Description": "ORT SLING ARM MEDIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2441",
            "Item/Package": "Item",
            "Description": "ORT SLING ARM LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5022",
            "Item/Package": "Item",
            "Description": "LAB ISTAT E3 PLUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "524",
            "Item/Package": "Item",
            "Description": "ENT SPONGE CYLINDR 3/8X11/21",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "177",
            "Item/Package": "Item",
            "Description": "SUTURE CHROMIC 2-0 CT-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "477",
            "Item/Package": "Item",
            "Description": "DRAPE C-ARM 42 X 64",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "471",
            "Item/Package": "Item",
            "Description": "SUTURE PDS II 1 CTX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "182",
            "Item/Package": "Item",
            "Description": "SUTURE CHROMIC 2-0 SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.31 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3938",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 1 TP-1 60",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11784",
            "Item/Package": "Item",
            "Description": "GOWN SURGICAL SMARTGOWN 3XL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "179",
            "Item/Package": "Item",
            "Description": "SUTURE CHROMIC 2-0 CT-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "190",
            "Item/Package": "Item",
            "Description": "SUTURE CHROMIC 3-0 SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "213",
            "Item/Package": "Item",
            "Description": "SUTURE CHROMIC 0 CT-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5001",
            "Item/Package": "Item",
            "Description": "TUBING IV PRIMARY ULTRASET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3946",
            "Item/Package": "Item",
            "Description": "SUTURE PLAIN 3-0 CT-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.71 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1062",
            "Item/Package": "Item",
            "Description": "PACKING IODOFORM 1/2 X 5YDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $17.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3533",
            "Item/Package": "Item",
            "Description": "ORT J SPLINT READY MADE 4X20",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1993",
            "Item/Package": "Item",
            "Description": "SUTURE CHROMIC 4-0 SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205",
            "Item/Package": "Item",
            "Description": "SUTURE CHROMIC 5-0 RB-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "290",
            "Item/Package": "Item",
            "Description": "CAUTERY PENCIL HAND CONTROL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5658",
            "Item/Package": "Item",
            "Description": "ANGIOCATH SAF-T-INTIMA 22GX3/4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "200",
            "Item/Package": "Item",
            "Description": "SUTURE CHROMIC 4-0 RB-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3135",
            "Item/Package": "Item",
            "Description": "ENDO BITE BLOCK PEDIATRIC 38FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5626",
            "Item/Package": "Item",
            "Description": "PUNCH BIOPSY 3MM DISP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "244",
            "Item/Package": "Item",
            "Description": "CAST TAPE DELTA WHITE 4X4YDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7361",
            "Item/Package": "Item",
            "Description": "CAUTERY BLADE EZ CLEAN 21/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1070",
            "Item/Package": "Item",
            "Description": "PACKING PLAIN 2 X 5YDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $18.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5907",
            "Item/Package": "Item",
            "Description": "SUTURE BOOTIES STD YELLOW",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.06 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5611",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 2-0 KS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5625",
            "Item/Package": "Item",
            "Description": "PUNCH BIOPSY 2MM DISP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.16 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5659",
            "Item/Package": "Item",
            "Description": "ANGIOCATH SAF-T-INTIMA 18GX1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "285",
            "Item/Package": "Item",
            "Description": "CAUTERY CORD BI-POLAR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5660",
            "Item/Package": "Item",
            "Description": "ANGIOCATH SAF-T-INTIMA 20GX1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3974",
            "Item/Package": "Item",
            "Description": "CATHETER TRAY 15 FR STRAIGHT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "858",
            "Item/Package": "Item",
            "Description": "SUTURE NEEDLE TONSIL 1/2 CIRC.",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1298",
            "Item/Package": "Item",
            "Description": "EYE BAL. SALT SOL 15ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "345",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 2-0 SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "288",
            "Item/Package": "Item",
            "Description": "CAUTERY NEEDLE EXTENDED TIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.71 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "287",
            "Item/Package": "Item",
            "Description": "CAUTERY BLADE EXTENDED TIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "159",
            "Item/Package": "Item",
            "Description": "SUTURE NEEDLE 1/2 CIRCLE TAPER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "342",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 0 SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5071",
            "Item/Package": "Item",
            "Description": "SUTURE CHROMIC 1  CT-1 27",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10003",
            "Item/Package": "Item",
            "Description": "DRESSING EXDRM SATN WOUND 4X4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "242",
            "Item/Package": "Item",
            "Description": "CAST TAPE DELTA WHITE 3X4YDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7172",
            "Item/Package": "Item",
            "Description": "HOLDER QUICK REL PT RESTRAINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "250",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 2-WAY 16 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "254",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 2-WAY 18 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8235",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 2-WAY 14 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8236",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 2-WAY 20 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8237",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 2-WAY 22 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9305",
            "Item/Package": "Item",
            "Description": "SUT NEEDLE MAYO 1/2 CIRCLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.13 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "351",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 3-0 SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2546",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 4-0 SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1171",
            "Item/Package": "Item",
            "Description": "ORT STOCKINETTE IMPERV 12X48",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3345",
            "Item/Package": "Item",
            "Description": "DRAPE MICROSCOPE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "326",
            "Item/Package": "Item",
            "Description": "SUTURE PLAIN 4-0 SC-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "491",
            "Item/Package": "Item",
            "Description": "GOWN SURGICAL SMARTGOWN XL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5455",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 0 CT 48",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8465",
            "Item/Package": "Item",
            "Description": "ORT TOURNI-COT LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7870",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 3-0 RB-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5739",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 5-0 30 RB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $20.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6916",
            "Item/Package": "Item",
            "Description": "OSTOMY FLANGE 4'' COLOSTOMY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $21.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2019",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 2-WAY 24 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $21.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1069",
            "Item/Package": "Item",
            "Description": "PACKING PLAIN 1/2 X 5YDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $21.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "509",
            "Item/Package": "Item",
            "Description": "ENT PK POPE EAR WICK 9X15MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $21.31 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3164",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 3-0  X-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $21.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5402",
            "Item/Package": "Item",
            "Description": "ORT STOCKINETTE DBL-PLY STRL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $21.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "257",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 5-0 P-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $21.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "398",
            "Item/Package": "Item",
            "Description": "SUTURE SILK 5-0 P-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $21.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "401",
            "Item/Package": "Item",
            "Description": "SUTURE SILK 6-0 P-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $22.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1160",
            "Item/Package": "Item",
            "Description": "ENT SPONGE NEURO 1/2 X 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $22.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11139",
            "Item/Package": "Item",
            "Description": "SPINE SPONGE NEURO 1X1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $22.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "261",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 5-0 PS-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $22.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8231",
            "Item/Package": "Item",
            "Description": "CATH FOLEY SILICONE 16 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $22.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8233",
            "Item/Package": "Item",
            "Description": "CATH FOLEY SILCONE 20FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $22.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11017",
            "Item/Package": "Item",
            "Description": "CATH FOLEY SILICONE 14FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $22.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3856",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 2-0 PS-18",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $22.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1162",
            "Item/Package": "Item",
            "Description": "ENT SPONGE NEURO 1/2  X 3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $22.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "428",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 3-0 PS-2 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $23.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1608",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 3-0 PS-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $23.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "480",
            "Item/Package": "Item",
            "Description": "DRAPE STERI U",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $23.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "255",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 4-0 PS-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $23.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "434",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 4-0 PS-2 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $23.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1101",
            "Item/Package": "Item",
            "Description": "PREP TRAY VAG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $23.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8232",
            "Item/Package": "Item",
            "Description": "CATH FOLEY SILCONE 18FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $23.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "438",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 5-0 PS-2 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $23.45 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5714",
            "Item/Package": "Item",
            "Description": "SUTURE ETHIBOND 3-0 EXCEL SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $23.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8328",
            "Item/Package": "Item",
            "Description": "DAVINCI PAD EGGCRATE 32X73X4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $23.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2619",
            "Item/Package": "Item",
            "Description": "GOWN SURGICAL SMARTGOWN 2XL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $23.62 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7693",
            "Item/Package": "Item",
            "Description": "TUBING IV FILTER FLOW VISTA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2962",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 2-WAY 20FR 30CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2976",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 2-WAY 22FR 30CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2978",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 2-WAY 24 FR 30CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7971",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 2-WAY 16 FR 30CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7972",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 2-WAY 18 FR 30CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7171",
            "Item/Package": "Item",
            "Description": "SUTURE ETHIBOND 3-0 RB-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "253",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 4-0 P-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5871",
            "Item/Package": "Item",
            "Description": "SUTURE ETHIBOND 0 DBL ARM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1748",
            "Item/Package": "Item",
            "Description": "SHOE POST OP MEN'S MEDIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1749",
            "Item/Package": "Item",
            "Description": "SHOE POST OP MEN'S LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1750",
            "Item/Package": "Item",
            "Description": "SHOE POST OP MEN'S X-LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1751",
            "Item/Package": "Item",
            "Description": "SHOE POST OP WOMEN'S SMALL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1752",
            "Item/Package": "Item",
            "Description": "SHOE POST OP WOMEN'S MEDIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1753",
            "Item/Package": "Item",
            "Description": "SHOE POST OP WOMEN'S LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10051",
            "Item/Package": "Item",
            "Description": "DRESSING MAXORB XTRA WOUND 4X4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "263",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 6-0 P-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11624",
            "Item/Package": "Item",
            "Description": "PAIN NEEDLE SPINAL 25Gx2 BD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3095",
            "Item/Package": "Item",
            "Description": "GYN LLETZ LOOP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $24.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1065",
            "Item/Package": "Item",
            "Description": "PACKING PLAIN 1 X 5YDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $25.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "249",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 3-0 PS-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $25.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "432",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 4-0 P-3 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $25.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12035",
            "Item/Package": "Item",
            "Description": "DRAPE LITHOTOMY POUCH FLUID",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $25.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1554",
            "Item/Package": "Item",
            "Description": "CYSTO TUR IRR TUBNG Y TYPE 90\"",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $25.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "258",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 5-0 PC-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $25.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "437",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 5-0 P-3 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $25.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "426",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 3-0 PS-1 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $25.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "391",
            "Item/Package": "Item",
            "Description": "SUTURE SILK 4-0 P-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $25.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2123",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 4-0 P-2 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $25.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "265",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 6-0 PC-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $26.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "440",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 6-0 P-3 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $26.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8464",
            "Item/Package": "Item",
            "Description": "ORT TOURNI-COT MEDIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $26.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12057",
            "Item/Package": "Item",
            "Description": "STOCKING TED THIGH SM SHRT 610",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $26.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12059",
            "Item/Package": "Item",
            "Description": "STOCKING TED THIGH SM LONG 612",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $26.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12064",
            "Item/Package": "Item",
            "Description": "STOCKING TED THIGH XLG SHRT640",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $26.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "364",
            "Item/Package": "Item",
            "Description": "DRAIN RESEVOIR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $26.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "414",
            "Item/Package": "Item",
            "Description": "SUTURE TI-CRON 5 HOS-14",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $26.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2683",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 5-0 PS-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "564",
            "Item/Package": "Item",
            "Description": "EYE NEEDLE ANT CHAMBER 30G",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1099",
            "Item/Package": "Item",
            "Description": "PREP DURA SURG SOL 26ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5315",
            "Item/Package": "Item",
            "Description": "PREP CHLORAPREP 10.5ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12058",
            "Item/Package": "Item",
            "Description": "STOCKING TED THIGH SM REG 611",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12060",
            "Item/Package": "Item",
            "Description": "STOCKING TED THIGH MED SHRT620",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12061",
            "Item/Package": "Item",
            "Description": "STOCKING TED THIGH MED LONG622",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12062",
            "Item/Package": "Item",
            "Description": "STOCKING TED THIGH LG SHRT 630",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12063",
            "Item/Package": "Item",
            "Description": "STOCKING TED THIGH LG LONG 632",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12065",
            "Item/Package": "Item",
            "Description": "STOCKING TED THIGH XLG LONG642",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2231",
            "Item/Package": "Item",
            "Description": "CAUTERY BLADE COATED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "502",
            "Item/Package": "Item",
            "Description": "ENT DRESSING NASAL HOLDER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $27.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2799",
            "Item/Package": "Item",
            "Description": "DRESSING STRATASORB 6 X 7.5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "293",
            "Item/Package": "Item",
            "Description": "CAUTERY NEEDLE COATED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7634",
            "Item/Package": "Item",
            "Description": "STOCKING TED THIGH XLG REG 641",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1167",
            "Item/Package": "Item",
            "Description": "STAPLER SKIN WIDE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3916",
            "Item/Package": "Item",
            "Description": "AIRWAY WILLIAMS ADULT M 10CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6799",
            "Item/Package": "Item",
            "Description": "PAD MUL T 15 X 22 TEMP THERAPY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6029",
            "Item/Package": "Item",
            "Description": "STOCKING TED THIGH LG REG 631",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "320",
            "Item/Package": "Item",
            "Description": "SUTURE PDS II 5-0 P-3 CLR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2744",
            "Item/Package": "Item",
            "Description": "DRAPE EYE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "854",
            "Item/Package": "Item",
            "Description": "SUTURE NEEDLE KEITH 2 7/8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1600",
            "Item/Package": "Item",
            "Description": "BLANKET WARMING PACU FULL BODY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3815",
            "Item/Package": "Item",
            "Description": "NEEDLE GRIPPER PLUS 20G90D 3/4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9446",
            "Item/Package": "Item",
            "Description": "NEEDLE GRIPPER PLUS 20G 90D 1\"",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "264",
            "Item/Package": "Item",
            "Description": "CATHETER TRAY FOLEY 16 FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1541",
            "Item/Package": "Item",
            "Description": "TUBE SALEM SUMP 18 FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $28.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3949",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 0 UND BR SUTUPAK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $29.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1996",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 5-0 P3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $29.15 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5663",
            "Item/Package": "Item",
            "Description": "DRAPE MAGNETIC TRANSFER 10X16",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $29.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2852",
            "Item/Package": "Item",
            "Description": "CATH FOLEY SILICONE 24FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $29.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2562",
            "Item/Package": "Item",
            "Description": "CAUTERY BLADE INSUL COATED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $29.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2251",
            "Item/Package": "Item",
            "Description": "CAUTERY NEEDLE INSUL COATED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $29.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5441",
            "Item/Package": "Item",
            "Description": "DRAPE TOP STERILE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $29.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6733",
            "Item/Package": "Item",
            "Description": "DRAIN FLAT 7MM X 20CM FULL PRF",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $29.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $20.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "129",
            "Item/Package": "Item",
            "Description": "SUTURE BONE WAX  2.5QM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $30.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $21.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5766",
            "Item/Package": "Item",
            "Description": "BINDER ABDOMINAL 3-PANEL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $30.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $21.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6028",
            "Item/Package": "Item",
            "Description": "STOCKING TED THIGH MED REG 621",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $30.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $21.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3552",
            "Item/Package": "Item",
            "Description": "DRAPE C-ARM MINI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $30.31 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $21.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5905",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 5-0 RB-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $30.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $21.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8734",
            "Item/Package": "Item",
            "Description": "TRAY ADD FOLEY W/BAG 897400",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $30.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $21.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8134",
            "Item/Package": "Item",
            "Description": "LAP TUBING INSUFFLATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $30.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $21.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9886",
            "Item/Package": "Item",
            "Description": "ENDO YOPSY IRRIGATION VALVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $30.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $21.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5132",
            "Item/Package": "Item",
            "Description": "TUBING IV 5 PORT BRAUN CUSTOM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $30.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $21.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3311",
            "Item/Package": "Item",
            "Description": "PAIN NEEDLE EPIDURAL 17GX31/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $31.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $21.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7584",
            "Item/Package": "Item",
            "Description": "ENDO POLYP TRAP FOUR CHAMBER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $31.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $21.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6975",
            "Item/Package": "Item",
            "Description": "DENTAL BUR TAPERED 702",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $31.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $21.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11124",
            "Item/Package": "Item",
            "Description": "SUT SILK 6/0 BV-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $31.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $22.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1614",
            "Item/Package": "Item",
            "Description": "PACKING IODOFORM 2 X 5YDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $31.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $22.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2083",
            "Item/Package": "Item",
            "Description": "SUTURE PDS II 3-0 PS-2 CLR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $31.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $22.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3748",
            "Item/Package": "Item",
            "Description": "CAUTERY BLADE EXTEND COAT 6.5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $32.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $22.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2635",
            "Item/Package": "Item",
            "Description": "SUTURE MONOCRYL 4-0 P-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $32.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $22.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1109",
            "Item/Package": "Item",
            "Description": "PREP IODINE PAINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $32.23 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $22.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "504",
            "Item/Package": "Item",
            "Description": "SHEET SPLIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $32.71 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $22.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "347",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 3-0 PS-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $32.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $22.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1058",
            "Item/Package": "Item",
            "Description": "ORT BUR ROUND CARBIDE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $32.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $22.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7044",
            "Item/Package": "Item",
            "Description": "CAUTERY BLADE EXTEND COAT 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $32.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $22.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "353",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 4-0 P-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $32.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "304",
            "Item/Package": "Item",
            "Description": "SUTURE MONOCRYL 3-0 PS-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $32.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1599",
            "Item/Package": "Item",
            "Description": "BLANKET WARMING LOWER BODY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $32.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1601",
            "Item/Package": "Item",
            "Description": "BLANKET WARMING UPPER BODY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $32.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "367",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 5-0 P-3 CLR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $33.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6976",
            "Item/Package": "Item",
            "Description": "DENTAL BUR TAPERED 703",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $33.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2175",
            "Item/Package": "Item",
            "Description": "PAIN NEEDLE SPINAL 22G X 7",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $33.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3952",
            "Item/Package": "Item",
            "Description": "SUTURE PDS II 0 CTX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $33.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "307",
            "Item/Package": "Item",
            "Description": "SUTURE MONOCRYL 4-0 PS-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $33.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "356",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 4-0 PS-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $33.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6599",
            "Item/Package": "Item",
            "Description": "CONTAINER SPECIMEN 4 OZ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $33.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3673",
            "Item/Package": "Item",
            "Description": "SUTURE PDS II",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $33.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5302",
            "Item/Package": "Item",
            "Description": "TUBING YTYPE BLOOD SET W/FILTR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $33.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6859",
            "Item/Package": "Item",
            "Description": "SUTURE SILK 3-0 BLK BR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $33.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3939",
            "Item/Package": "Item",
            "Description": "SUTURE MONOCRYL 4-0 PS-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $34.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "319",
            "Item/Package": "Item",
            "Description": "SUTURE PDS II 4-0 PS-2 CLR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $34.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "187",
            "Item/Package": "Item",
            "Description": "SUTURE CHROMIC 3-0 PS-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $34.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2543",
            "Item/Package": "Item",
            "Description": "SUTURE PLAIN 3-0 PS-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $34.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721",
            "Item/Package": "Item",
            "Description": "HEMOCLIP MEDIUM BLUE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $34.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9612",
            "Item/Package": "Item",
            "Description": "NEEDLE CHIBA 22GX8\"",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $35.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5904",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 4-0 RB-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $35.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "360",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 6-0 P-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $35.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5694",
            "Item/Package": "Item",
            "Description": "SUTURE SURGILON 0 BLK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $35.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "365",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 4-0 P-3 CLR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $35.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7869",
            "Item/Package": "Item",
            "Description": "SUTURE MONOCRYL 4-0 P-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $35.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "204",
            "Item/Package": "Item",
            "Description": "SUTURE CHROMIC 5-0 P-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $35.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $25.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5736",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 6-0 30 RB-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $35.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $25.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "309",
            "Item/Package": "Item",
            "Description": "SUTURE MONOCRYL 5-0 P-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $36.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $25.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "195",
            "Item/Package": "Item",
            "Description": "SUTURE CHROMIC 4-0 PS-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $36.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $25.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "886",
            "Item/Package": "Item",
            "Description": "PAIN NEEDLE SPINAL 22G X 5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $36.62 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $25.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "349",
            "Item/Package": "Item",
            "Description": "SUTURE PROLENE 3-0 PS-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $36.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $25.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "193",
            "Item/Package": "Item",
            "Description": "SUTURE CHROMIC 4-0 P-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $37.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3907",
            "Item/Package": "Item",
            "Description": "BLANKET WARMING PEDIATRIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $37.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5899",
            "Item/Package": "Item",
            "Description": "LAB TEST STRIP COAGUCHEK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $37.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "160",
            "Item/Package": "Item",
            "Description": "BINDER ABDOMINAL 4-PANEL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $37.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10669",
            "Item/Package": "Item",
            "Description": "BINDER ABDOMINAL 4-PANEL 30-45",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $37.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3752",
            "Item/Package": "Item",
            "Description": "SUTURE MONOCRYL 4-0 PC-12",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $37.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "501",
            "Item/Package": "Item",
            "Description": "SHEET LAP T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $37.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "528",
            "Item/Package": "Item",
            "Description": "ENT CAUTERY SUCTION 10 FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $37.94 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2622",
            "Item/Package": "Item",
            "Description": "DRAPE IOBAN 35 X 17",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $37.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9356",
            "Item/Package": "Item",
            "Description": "HEADREST INTUB SLOT PILLOW",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $38.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6926",
            "Item/Package": "Item",
            "Description": "ORT PIN BALL JURGAN 0.35 BLUE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $38.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11727",
            "Item/Package": "Item",
            "Description": "ENDO DEFENDO AIRWATER BUTTN KT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $38.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "330",
            "Item/Package": "Item",
            "Description": "SUTURE PLAIN 5-0 FAST ABS PC-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $38.58 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "499",
            "Item/Package": "Item",
            "Description": "DRAPE EXTREMITY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $38.58 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1193",
            "Item/Package": "Item",
            "Description": "SUPPORTER ATHLETIC LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $38.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3342",
            "Item/Package": "Item",
            "Description": "DRAPE PEDIATRIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $39.23 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7006",
            "Item/Package": "Item",
            "Description": "ANES CIRCUIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $39.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8339",
            "Item/Package": "Item",
            "Description": "DAVINCI LAP SCOPE WARMER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $39.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3861",
            "Item/Package": "Item",
            "Description": "GYN COLLECTION SET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $39.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2452",
            "Item/Package": "Item",
            "Description": "PAIN NEEDLE STELLATE 22G X 2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $40.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $28.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "474",
            "Item/Package": "Item",
            "Description": "PACK CYSTO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $40.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $28.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "585",
            "Item/Package": "Item",
            "Description": "EYE KNIFE 15 DEGREE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $41.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $28.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "247",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 10 FR 3CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $41.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $28.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6391",
            "Item/Package": "Item",
            "Description": "SUTURE MONOCRYL 3-0 PS 1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $41.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1657",
            "Item/Package": "Item",
            "Description": "ORT BLADE OSCILLATING MICRO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $41.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1658",
            "Item/Package": "Item",
            "Description": "ORT BLADE OSCILLATING MICRO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $41.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1659",
            "Item/Package": "Item",
            "Description": "ORT BLADE OSCILLATING MICRO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $41.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1738",
            "Item/Package": "Item",
            "Description": "ORT BLADE SAGITTAL MICRO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $41.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1740",
            "Item/Package": "Item",
            "Description": "ORT BLADE SAGITTAL MICRO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $41.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1742",
            "Item/Package": "Item",
            "Description": "ORT BLADE SAGITTAL MICRO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $41.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1766",
            "Item/Package": "Item",
            "Description": "ORT BLADE OSCILLATING MICRO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $41.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2245",
            "Item/Package": "Item",
            "Description": "ORT BLADE OSCILLATING MICRO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $41.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1004",
            "Item/Package": "Item",
            "Description": "ORT BUR ROUND 2MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $42.15 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2439",
            "Item/Package": "Item",
            "Description": "EYE POLISHER CAPSULE  27G",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $42.45 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5817",
            "Item/Package": "Item",
            "Description": "GYN CANISTER FLUID SAFE 3000CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $42.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3161",
            "Item/Package": "Item",
            "Description": "EYE KNIFE 30 DEGREE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $42.58 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730",
            "Item/Package": "Item",
            "Description": "AMBU BAG ADULT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $42.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "465",
            "Item/Package": "Item",
            "Description": "ORT WIRE 18G/18\"",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $43.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $30.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12067",
            "Item/Package": "Item",
            "Description": "STOCKING TED THGH ATS XXXL 361",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $43.40 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $30.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "408",
            "Item/Package": "Item",
            "Description": "ORT WIRE 28G/18\"",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $43.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $30.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3261",
            "Item/Package": "Item",
            "Description": "BAG URIMETER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $43.45 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $30.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "332",
            "Item/Package": "Item",
            "Description": "SUTURE PLAIN 6-0 FAST ABS PC-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $43.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $30.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5303",
            "Item/Package": "Item",
            "Description": "FILTER BLOOD TRANSFUS 40 MICR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $43.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $30.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2788",
            "Item/Package": "Item",
            "Description": "NEEDLE SPINAL 22GA X 2 1/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $44.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $31.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6516",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 0S-8 BR VIL.",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $44.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $31.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2371",
            "Item/Package": "Item",
            "Description": "AMBU BAG PEDIATRIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $45.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $31.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12066",
            "Item/Package": "Item",
            "Description": "STOCKING TED THIGH ATS XXL 351",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $45.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $32.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6823",
            "Item/Package": "Item",
            "Description": "PAIN NEEDLE EPIDURAL 17GX41/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $46.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $32.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2896",
            "Item/Package": "Item",
            "Description": "CYSTO CATH URETERAL WHISTLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $47.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $33.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "507",
            "Item/Package": "Item",
            "Description": "SHEET TRANSVERSE LAP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $47.23 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $33.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8136",
            "Item/Package": "Item",
            "Description": "RAD COVER TRANSDUCER CIV-FLEX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $47.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $33.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10303",
            "Item/Package": "Item",
            "Description": "PAIN NEEDLE TUOHY 18G 6\"",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $47.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $33.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2029",
            "Item/Package": "Item",
            "Description": "SUTURE PLAIN 6-0 G-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $49.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $34.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3241",
            "Item/Package": "Item",
            "Description": "GYN ELECTR EXTENDER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $49.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $34.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "498",
            "Item/Package": "Item",
            "Description": "DRAPE EXTREMITY BILATERAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $50.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $35.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5316",
            "Item/Package": "Item",
            "Description": "PREP CHLORAPREP 26ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $50.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $35.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1042",
            "Item/Package": "Item",
            "Description": "ORT BUR TAPERED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $50.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $35.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5354",
            "Item/Package": "Item",
            "Description": "ORT DRAIN EVACUATOR 400 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $50.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $35.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11273",
            "Item/Package": "Item",
            "Description": "ORT DRAIN EVACUATOR 400ML 1/4\"",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $50.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $35.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2883",
            "Item/Package": "Item",
            "Description": "CYSTO TORQUE VISE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $52.02 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $36.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7580",
            "Item/Package": "Item",
            "Description": "ENDO SNARE SOFT 15MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $52.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $36.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2996",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 3 WAY 22 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $52.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $36.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10388",
            "Item/Package": "Item",
            "Description": "COVER DISP HEADLIGHT JOYSTICK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $53.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $37.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10785",
            "Item/Package": "Item",
            "Description": "LAP SCOPE/TROCAR SWABS W/CLOTH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $53.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $37.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1922",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 3-WAY 24 FR 30CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $53.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $37.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "510",
            "Item/Package": "Item",
            "Description": "DRAPE HAND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $54.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $37.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2994",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 3-WAY 18FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $54.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $38.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3315",
            "Item/Package": "Item",
            "Description": "CYSTO BAG TABLE DRAIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $54.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $38.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2997",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 3 WAY 24 FR 5 CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $55.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $38.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11171",
            "Item/Package": "Item",
            "Description": "DRESSING MEPILEX FOAM 6X6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $55.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $38.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3093",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 3 WAY 20 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $55.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $39.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5136",
            "Item/Package": "Item",
            "Description": "ENDO FORCEP RJ LRG W/NEEDLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $55.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $39.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8828",
            "Item/Package": "Item",
            "Description": "ENDO SNARE CAPTIVATOR2 15MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $55.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $39.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8829",
            "Item/Package": "Item",
            "Description": "ENDO SNARE CAPTIVATOR2 10MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $55.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $39.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9074",
            "Item/Package": "Item",
            "Description": "DAVINCI ENDWRST STPLR MOTR PK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $56.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $39.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6502",
            "Item/Package": "Item",
            "Description": "DRESSING BIOPATCH DISK  W CHG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $56.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $39.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7967",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 3-WAY 30FR 30CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $56.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $39.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5138",
            "Item/Package": "Item",
            "Description": "ENDO FORCEP RJ LRG NEEDLELESS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $56.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $39.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "774",
            "Item/Package": "Item",
            "Description": "LAP KITNER DISSECTOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $57.31 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $40.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8990",
            "Item/Package": "Item",
            "Description": "EYE KNIFE SLIT ANGLED 2.2MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $58.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $40.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6930",
            "Item/Package": "Item",
            "Description": "SUTURE ETHIBOND 2-0 EXCEL SH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $58.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $40.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2758",
            "Item/Package": "Item",
            "Description": "CYSTO CATH URETERAL CONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $58.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $41.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "568",
            "Item/Package": "Item",
            "Description": "IRRIGATION NACL 3000 CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $59.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $41.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "559",
            "Item/Package": "Item",
            "Description": "IRRIGATION LACTATED RING 3000",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $60.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $42.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8247",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 3-WAY 24 FR 30CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $60.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $42.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5120",
            "Item/Package": "Item",
            "Description": "LAB ABAXIS PICCOLO BASIC METAB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $60.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $42.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10515",
            "Item/Package": "Item",
            "Description": "SYRINGE 10CC GLASS RESISTANT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $61.01 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $42.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8246",
            "Item/Package": "Item",
            "Description": "CATH FOLEY 3-WAY 22 FR 30CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $61.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5440",
            "Item/Package": "Item",
            "Description": "DRAPE EXTREMITY T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $62.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2857",
            "Item/Package": "Item",
            "Description": "IRRIGATION STER WATER 3000CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $62.31 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3221",
            "Item/Package": "Item",
            "Description": "SUPPORTER ATHLETIC LG. POUCH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $62.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3309",
            "Item/Package": "Item",
            "Description": "EYE CANNULA J-SHAPE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $62.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3866",
            "Item/Package": "Item",
            "Description": "TOURNIQUET STER. 12'' SP/SB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $62.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3867",
            "Item/Package": "Item",
            "Description": "TOURNIQUET STER. 18'' SP/SB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $62.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3868",
            "Item/Package": "Item",
            "Description": "TOURNIQUET STER. 24'' SP/SB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $62.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3869",
            "Item/Package": "Item",
            "Description": "TOURNIQUET STER. 30'' SP/SB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $62.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3870",
            "Item/Package": "Item",
            "Description": "TOURNIQUET STER. 34'' SP/SB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $62.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3871",
            "Item/Package": "Item",
            "Description": "TOURNIQUET STER. 44'' SP/SB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $62.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "769",
            "Item/Package": "Item",
            "Description": "LAP NEEDLE INSUFFLAT 150MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $63.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $44.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4951",
            "Item/Package": "Item",
            "Description": "SUTURE NUROLON 0 CT-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $63.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $44.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7422",
            "Item/Package": "Item",
            "Description": "KIT CENTRAL LINE DRESSING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $63.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $44.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1761",
            "Item/Package": "Item",
            "Description": "CRUTCHES ALUMINUM MED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $64.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $45.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2684",
            "Item/Package": "Item",
            "Description": "CRUTCHES ALUMINUM TALL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $64.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $45.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3120",
            "Item/Package": "Item",
            "Description": "ENDO BRUSH CYTOLOGY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $64.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $45.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2648",
            "Item/Package": "Item",
            "Description": "CYSTO CATH URETERAL OPEN 5FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $64.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $45.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5556",
            "Item/Package": "Item",
            "Description": "CRUTCHES ALUMINUM YOUTH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $64.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $45.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6790",
            "Item/Package": "Item",
            "Description": "LAP NEEDLE INSUFFLAT 120MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $65.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $45.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6379",
            "Item/Package": "Item",
            "Description": "FILTER BACTERIA WHITE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $65.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $45.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5401",
            "Item/Package": "Item",
            "Description": "DRAPE IOBAN 23 X 33",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $65.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $45.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2816",
            "Item/Package": "Item",
            "Description": "ORT BUR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $65.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $45.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5628",
            "Item/Package": "Item",
            "Description": "DERMACARRIER 1.5 - 1 STERILE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $66.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "725",
            "Item/Package": "Item",
            "Description": "HEMOCLIP SMALL YELLOW",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $66.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2894",
            "Item/Package": "Item",
            "Description": "CATH COUDE 22 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $66.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3257",
            "Item/Package": "Item",
            "Description": "CATH COUDE 16 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $66.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3258",
            "Item/Package": "Item",
            "Description": "CATH COUDE 18 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $66.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3259",
            "Item/Package": "Item",
            "Description": "CATH COUDE 20 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $66.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9395",
            "Item/Package": "Item",
            "Description": "CATH COUDE 14FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $66.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8004",
            "Item/Package": "Item",
            "Description": "DRESSING AQUACEL AG 4 X 5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $66.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5307",
            "Item/Package": "Item",
            "Description": "CATHETER RADIAL ARTERY 20G",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $68.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $47.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3943",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 0 CR/CT-1 UND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $68.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $48.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7199",
            "Item/Package": "Item",
            "Description": "PAIN GROUNDING PAD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $68.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $48.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10644",
            "Item/Package": "Item",
            "Description": "CANISTER DISP SUCTION 2100ML ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $68.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $48.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "847",
            "Item/Package": "Item",
            "Description": "RAD NEEDLE LOC HAWKINS 5.0CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $68.94 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $48.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10158",
            "Item/Package": "Item",
            "Description": "ORT COAXIAL FEMORAL CANAL TIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $69.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $48.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9152",
            "Item/Package": "Item",
            "Description": "RAD CVR TRNSDCER CIV 14X147CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $70.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $49.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "302",
            "Item/Package": "Item",
            "Description": "CAUTERY HIGH TEMP FINE TIP DSP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $71.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $50.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5313",
            "Item/Package": "Item",
            "Description": "TUBING BLOOD WARMING STD FLOW",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $71.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $50.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4027",
            "Item/Package": "Item",
            "Description": "VENOFLOW ELITE CALF",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $72.03 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $50.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5015",
            "Item/Package": "Item",
            "Description": "LAB ABAXIS PICCOLO CMP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $73.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $51.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "168",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 5-0 S-24",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $73.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $51.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "778",
            "Item/Package": "Item",
            "Description": "LAP NEEDLE INSUFFLAT 120MM ETH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $74.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $52.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3639",
            "Item/Package": "Item",
            "Description": "CAUTERY ASPIRATION TIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $74.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $52.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6886",
            "Item/Package": "Item",
            "Description": "OSTOMY LOOP ROD 2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $74.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $52.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12120",
            "Item/Package": "Item",
            "Description": "EYE PHACO NEEDLE SLEEVE 2.4MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $75.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $52.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1635",
            "Item/Package": "Item",
            "Description": "ORT K-WIRE 1.25MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $76.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $53.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2270",
            "Item/Package": "Item",
            "Description": "ORT SMFRAG K-WIRE TI 2/150MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $76.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $53.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10394",
            "Item/Package": "Item",
            "Description": "SUT VICRYL PLUS 0 CT-1 18\"",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $76.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $53.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2614",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 5-0 S-22",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $77.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $54.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "494",
            "Item/Package": "Item",
            "Description": "DRAPE LITHOTOMY W/FLUID POUCH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $78.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $54.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5617",
            "Item/Package": "Item",
            "Description": "LAP TROCAR SLEEVE 5X100MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $78.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $54.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2841",
            "Item/Package": "Item",
            "Description": "CATH COUNCILL 18 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $78.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $54.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2842",
            "Item/Package": "Item",
            "Description": "CATH COUNCILL 20 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $78.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $54.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7973",
            "Item/Package": "Item",
            "Description": "CATH COUNCIL 16FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $78.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $54.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5893",
            "Item/Package": "Item",
            "Description": "EYE MASK TRANSDERMAL STERILE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $78.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $55.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11179",
            "Item/Package": "Item",
            "Description": "SUT VICRYL PLUS CT-1 CR 8X18\"",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $79.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $55.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6087",
            "Item/Package": "Item",
            "Description": "NEEDLE ECHO STIMULTRA 22X31/8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $79.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $55.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "175",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 8-0 TG-140-8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $80.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $56.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9710",
            "Item/Package": "Item",
            "Description": "ENDO SNARE CAPTIVATOR2 20STIF",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $80.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $56.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "798",
            "Item/Package": "Item",
            "Description": "GYN LLETZ BALL 5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $80.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $56.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "805",
            "Item/Package": "Item",
            "Description": "GYN LLETZ LOOP WIDE 20 X 12",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $80.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $56.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "799",
            "Item/Package": "Item",
            "Description": "GYN LLETZ LOOP MED 15 X 12MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $80.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $56.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8217",
            "Item/Package": "Item",
            "Description": "DAVINCI CLIP APPL MED/LG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $81.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $56.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3114",
            "Item/Package": "Item",
            "Description": "CYSTO SEAL 7FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $81.16 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $56.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8373",
            "Item/Package": "Item",
            "Description": "PACK QUINTUBE MONITOR EVACUATE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $81.16 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $56.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7465",
            "Item/Package": "Item",
            "Description": "GYN VACCUUM SYSTEM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $81.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $56.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1009",
            "Item/Package": "Item",
            "Description": "ORT BUR ROUND 3MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $81.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $57.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "801",
            "Item/Package": "Item",
            "Description": "GYN LLETZ LOOP SMALL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $82.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $57.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "803",
            "Item/Package": "Item",
            "Description": "GYN LLETZ BALL 3MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $82.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $57.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12119",
            "Item/Package": "Item",
            "Description": "EYE PHACO NEEDLE SLEEVE 1.8MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $82.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $57.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "303",
            "Item/Package": "Item",
            "Description": "SUTURE MERSILENE 5-0 S-14",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $82.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $57.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3459",
            "Item/Package": "Item",
            "Description": "ENDO SNARE HEXAGON MEDIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $82.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $57.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6913",
            "Item/Package": "Item",
            "Description": "ENDO SNARE HEXAGON SMALL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $82.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $57.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "912",
            "Item/Package": "Item",
            "Description": "ORT K-WIRE 1.00MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $82.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $58.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80398",
            "Item/Package": "Item",
            "Description": "2.0MM KWIRE 150MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $82.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $58.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6988",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 2 TP-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $83.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $58.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1771",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 6-0 S-14",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $83.15 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $58.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10004",
            "Item/Package": "Item",
            "Description": "STOCKING TED THIGH XX-LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $83.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $58.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "225",
            "Item/Package": "Item",
            "Description": "SUTURE VICRYL 6-0 S-24",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $83.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $58.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5020",
            "Item/Package": "Item",
            "Description": "LAB ABAXIS PICCOLO LIVER PLUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $85.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $59.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3603",
            "Item/Package": "Item",
            "Description": "BANDAGE TUBEGUAZE SZ 3 ELASTIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $86.02 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $60.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3675",
            "Item/Package": "Item",
            "Description": "ORT HUMERAL STEM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $86.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $60.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8218",
            "Item/Package": "Item",
            "Description": "DAVINCI CLIP APPL LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $87.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $61.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2168",
            "Item/Package": "Item",
            "Description": "PAIN TRAY NERVE BLOCK SUPPORT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $87.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $61.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3174",
            "Item/Package": "Item",
            "Description": "ORT ROD TITANIUM CURVED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $87.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $61.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2325",
            "Item/Package": "Item",
            "Description": "ORT SMFRAG K-WIRE 1.60/150MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $88.03 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $61.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1146",
            "Item/Package": "Item",
            "Description": "ENDO SNARE LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $90.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $63.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "572",
            "Item/Package": "Item",
            "Description": "EYE KNIFE CRESCENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $90.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $63.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5950",
            "Item/Package": "Item",
            "Description": "SUTURE ETHIBOND 2-0 EXCEL V-37",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $90.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $63.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11873",
            "Item/Package": "Item",
            "Description": "DRAPE PACK SHOULDER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $92.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $64.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "627",
            "Item/Package": "Item",
            "Description": "PAIN TRAY EPIDURAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $93.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $65.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3145",
            "Item/Package": "Item",
            "Description": "GYN LLETZ LOOP SAFETY GAUGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $93.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $65.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3146",
            "Item/Package": "Item",
            "Description": "GYN LLETZ LOOP SAFETY GAUGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $93.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $65.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3147",
            "Item/Package": "Item",
            "Description": "GYN LLETZ LOOP SAFETY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $93.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $65.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3168",
            "Item/Package": "Item",
            "Description": "ORT BUR 6.5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $93.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $65.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4028",
            "Item/Package": "Item",
            "Description": "VENOFLOW ELITE CALF XL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $93.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $65.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5524",
            "Item/Package": "Item",
            "Description": "ORT PILLOW MEDIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $94.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $66.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7890",
            "Item/Package": "Item",
            "Description": "TRAY SPINAL W/PENCAN  24G X 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $95.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $66.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3057",
            "Item/Package": "Item",
            "Description": "EYE BAL. SALT SOL REG 500ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $95.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $66.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6234",
            "Item/Package": "Item",
            "Description": "HEMOSTATIC APPLICATOR ARISTA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $95.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $66.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3606",
            "Item/Package": "Item",
            "Description": "TUBING ULTRA LIMP STD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $95.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $66.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6483",
            "Item/Package": "Item",
            "Description": "ORT FACE MASK T-MAX DISP.",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $96.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $67.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7169",
            "Item/Package": "Item",
            "Description": "PAIN CANNULA 10CM X 20 GA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $96.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $67.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7336",
            "Item/Package": "Item",
            "Description": "PAIN CANNULA 1CM 10MM 20G",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $96.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $67.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10281",
            "Item/Package": "Item",
            "Description": "PAIN CANNULA 5CM X 20G",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $96.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $67.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11653",
            "Item/Package": "Item",
            "Description": "PAIN CANNULA STR 5CM 5MM 22G",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $96.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $67.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7766",
            "Item/Package": "Item",
            "Description": "SUCTION MANIFOLD 4 PORT STD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $96.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $67.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2326",
            "Item/Package": "Item",
            "Description": "ORT SMFRAG CLVRLF PLATE 4H/104",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $97.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $68.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "359",
            "Item/Package": "Item",
            "Description": "DRAIN BLAKE 15 FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $97.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $68.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7662",
            "Item/Package": "Item",
            "Description": "DRAIN BLAKE HUBLESS 15 FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $97.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $68.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10195",
            "Item/Package": "Item",
            "Description": "DRAIN BLAKEHUBLESS FLUTTED10FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $97.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $68.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5297",
            "Item/Package": "Item",
            "Description": "ORT CEMENT NOZZLE FLEX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $97.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $68.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "488",
            "Item/Package": "Item",
            "Description": "PACK ENT II",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $97.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $68.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1001",
            "Item/Package": "Item",
            "Description": "ORT BUR OVAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $99.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $69.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1011",
            "Item/Package": "Item",
            "Description": "ORT BUR STD FLUTED OVAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $99.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $69.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6652",
            "Item/Package": "Item",
            "Description": "ORT CEMENT PRESSUR FEM. CANNAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $100.06 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $70.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3324",
            "Item/Package": "Item",
            "Description": "TUBING INFUSION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $100.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $70.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8292",
            "Item/Package": "Item",
            "Description": "DAVINCI LAP TUBING INSUFFL HF",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $101.02 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $70.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5892",
            "Item/Package": "Item",
            "Description": "ENT DRESSING GLASSCOCK EAR ADT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $101.15 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $70.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5836",
            "Item/Package": "Item",
            "Description": "MAMMARY FLUID TRANSFER SET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $101.45 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $71.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "503",
            "Item/Package": "Item",
            "Description": "SHEET LAVH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $101.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $71.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3567",
            "Item/Package": "Item",
            "Description": "LAP TROCAR SLEEVE 5X75MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $101.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $71.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9633",
            "Item/Package": "Item",
            "Description": "GUIDES BIPLANE BX STR DISP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $102.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $71.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10579",
            "Item/Package": "Item",
            "Description": "DRAPE C-ARM 9IN FUSION CASES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $103.02 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $72.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8254",
            "Item/Package": "Item",
            "Description": "DAVINCI CLIP APPL MED/LG 5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $103.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $72.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11127",
            "Item/Package": "Item",
            "Description": "SUT STRATAFIX 3-0 PGA/PCL FS-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $103.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $72.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5737",
            "Item/Package": "Item",
            "Description": "SUTURE NUROLON 4-0 BLK BR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $106.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $74.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2919",
            "Item/Package": "Item",
            "Description": "PACK UNIVERSAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $106.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $74.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8490",
            "Item/Package": "Item",
            "Description": "IRRIGATION GLYCINE 1.5% 3000CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $106.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $74.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "613",
            "Item/Package": "Item",
            "Description": "ENDO FORCEP HOT 240CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $107.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $75.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8340",
            "Item/Package": "Item",
            "Description": "SUTURE CHROMIC 4-0 G-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $108.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $75.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2843",
            "Item/Package": "Item",
            "Description": "CATH COUNCILL 22 FR 5CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $109.13 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $76.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2869",
            "Item/Package": "Item",
            "Description": "CYSTO CORD ACTIVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $109.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $76.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3535",
            "Item/Package": "Item",
            "Description": "STAPLER SKIN WIDE ROTATE HEAD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $109.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $76.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "157",
            "Item/Package": "Item",
            "Description": "ADHESIVE SKIN DERMABOND ADVANC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $109.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $76.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3605",
            "Item/Package": "Item",
            "Description": "ORT KIT POSITIONING KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $110.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $77.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11475",
            "Item/Package": "Item",
            "Description": "ANGIOCATH SPECIAL LGT 12GX3\"",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $111.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $77.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3481",
            "Item/Package": "Item",
            "Description": "LAP CLOSURE SYS SUT PAS10/12MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $112.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $78.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8201",
            "Item/Package": "Item",
            "Description": "DAVINCI DRAPE CAMERA ARM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $112.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $78.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8224",
            "Item/Package": "Item",
            "Description": "DAVINCI CANNULA SEAL 8.5-13MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $112.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $78.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4029",
            "Item/Package": "Item",
            "Description": "VENOFLOW ELITE CALF BARIATRIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $117.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $82.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5391",
            "Item/Package": "Item",
            "Description": "ORT HOOD FLYTE SURGICOOL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $118.62 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $83.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10864",
            "Item/Package": "Item",
            "Description": "SPINE NEEDLE JAMSHI QC DI 11G",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $118.62 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $83.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3149",
            "Item/Package": "Item",
            "Description": "SMOKE EVAC TUBING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $124.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $87.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8204",
            "Item/Package": "Item",
            "Description": "DAVINCI TIP COVER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $124.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $87.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9015",
            "Item/Package": "Item",
            "Description": "DAVINCI ENDOWRIST CANNULA SEAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $124.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $87.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9016",
            "Item/Package": "Item",
            "Description": "DAVINCI ENDOWRIST SHEATH 45",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $124.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $87.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2789",
            "Item/Package": "Item",
            "Description": "SURGIBRA MED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $125.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $87.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2790",
            "Item/Package": "Item",
            "Description": "SURGIBRA LG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $125.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $87.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3125",
            "Item/Package": "Item",
            "Description": "SURGIBRA XL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $125.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $87.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9627",
            "Item/Package": "Item",
            "Description": "URONAV SENSOR CLIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $125.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $87.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7256",
            "Item/Package": "Item",
            "Description": "SMOKE EVAC TUBING W/WAND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $125.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $87.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9634",
            "Item/Package": "Item",
            "Description": "GUIDES DURAL BX STR STR DISP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $126.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $88.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "433",
            "Item/Package": "Item",
            "Description": "ENT PK KENNEDY SINUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $127.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $89.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5296",
            "Item/Package": "Item",
            "Description": "ORT BLADE SAGITTAL MED LG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $127.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $89.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4030",
            "Item/Package": "Item",
            "Description": "SCD FOOT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $127.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $89.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5378",
            "Item/Package": "Item",
            "Description": "ORT BLADE SAGITTAL HD OFFS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $128.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $90.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9369",
            "Item/Package": "Item",
            "Description": "SUT STRATAFIX PDS PLUS CT-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $130.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $91.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4914",
            "Item/Package": "Item",
            "Description": "ORT BLADE AGRESSIVE PLUS 4.0MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $133.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $93.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6587",
            "Item/Package": "Item",
            "Description": "LAP SURGIFISH VISCERA RTNR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $134.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $93.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "355",
            "Item/Package": "Item",
            "Description": "DRAIN SNYDER HEMO 1/8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $134.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $94.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5715",
            "Item/Package": "Item",
            "Description": "ORT BUR OVAL 4 X 8MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $135.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $94.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3290",
            "Item/Package": "Item",
            "Description": "ORT J SPLINT READY MADE 5X20",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $135.45 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $94.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5709",
            "Item/Package": "Item",
            "Description": "LAP ELECTRODE L-HOOK 2.4MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $136.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $95.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "848",
            "Item/Package": "Item",
            "Description": "RAD NEEDLE LOC HAWKINS 7.5CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $136.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $95.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7706",
            "Item/Package": "Item",
            "Description": "CYSTO CATH URETERAL CONNECTOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $136.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $95.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5555",
            "Item/Package": "Item",
            "Description": "ORT BILATERAL EVAC SET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $136.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $95.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3435",
            "Item/Package": "Item",
            "Description": "ORT ARTHREX FIBERWIRE 2 NDL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $137.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $96.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7934",
            "Item/Package": "Item",
            "Description": "GYN ELECTR SPATULA THIN CURVED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $137.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $96.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81731",
            "Item/Package": "Item",
            "Description": "MISC TOTAL JOINT SUPPLY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $139.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $97.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4048",
            "Item/Package": "Item",
            "Description": "CYSTO GLDWIRE .035 FLXTIP BEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $139.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $97.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6420",
            "Item/Package": "Item",
            "Description": "VASC GUIDEWIRE 0.35",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $139.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $97.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5523",
            "Item/Package": "Item",
            "Description": "ORT PILLOW SMALL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $139.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $97.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11870",
            "Item/Package": "Item",
            "Description": "APPLICATOR SURGICEL ENDOSCOPIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $141.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $98.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2537",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 10-0 VAS 100-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $142.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $99.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3126",
            "Item/Package": "Item",
            "Description": "SURGIBRA XXL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $142.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $99.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5998",
            "Item/Package": "Item",
            "Description": "LAP TROCAR 5X100MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $143.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $100.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6001",
            "Item/Package": "Item",
            "Description": "LAP TROCAR 8X100MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $143.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $100.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6962",
            "Item/Package": "Item",
            "Description": "LAP TROCAR 5X150MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $143.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $100.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7738",
            "Item/Package": "Item",
            "Description": "LAP TROCAR SP CLN 5X100MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $143.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $100.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3922",
            "Item/Package": "Item",
            "Description": "LAP TROCAR 5X75MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $143.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $100.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3964",
            "Item/Package": "Item",
            "Description": "LAP TROCAR XCEL 11X100MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $144.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $101.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6030",
            "Item/Package": "Item",
            "Description": "LAP TROCAR BLUNT TIP 12X100MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $146.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $102.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10078",
            "Item/Package": "Item",
            "Description": "ORT BLADE PREC SAW THIN OFF25M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $147.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $103.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10080",
            "Item/Package": "Item",
            "Description": "ORT PREC SAW THIN 9.0X18.5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $147.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $103.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10082",
            "Item/Package": "Item",
            "Description": "ORT BLADE PREC SAW THIN OFF43M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $147.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $103.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10079",
            "Item/Package": "Item",
            "Description": "ORT BLADE THIN OFF 9.0X25.0MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $148.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $103.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3523",
            "Item/Package": "Item",
            "Description": "GYN MANIPULATOR KRONNER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $148.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $103.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5809",
            "Item/Package": "Item",
            "Description": "SPINE HEAD HALTER LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $148.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $103.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8329",
            "Item/Package": "Item",
            "Description": "DAVINCI VLOC 180 0 GR6 GS21",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $149.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $104.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8330",
            "Item/Package": "Item",
            "Description": "DAVINCI VLOC 90 3/0 VL 9CV23",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $149.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $104.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8331",
            "Item/Package": "Item",
            "Description": "DAVINCI VLOC 90 3/0 UD 9CV23",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $149.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $104.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8337",
            "Item/Package": "Item",
            "Description": "DAVINCI VLOC 180 0 GR9 GS21",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $149.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $104.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8375",
            "Item/Package": "Item",
            "Description": "DAVINCI VLOC NONABS 0BL6 GS21",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $149.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $104.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11473",
            "Item/Package": "Item",
            "Description": "SUT VLOC 90 2/0 UD6 GS-22",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $149.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $104.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6241",
            "Item/Package": "Item",
            "Description": "SUTURE GORTEX CV-2 THX-26",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $149.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $104.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7004",
            "Item/Package": "Item",
            "Description": "MASK PERFORMATRAK HGDR MED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $149.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $104.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7005",
            "Item/Package": "Item",
            "Description": "MASK PERFORMATRAK HGDR LG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $149.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $104.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5622",
            "Item/Package": "Item",
            "Description": "LAP TROCAR 12X100MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $150.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $105.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2536",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 9-0 VAS 100-4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $150.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $105.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5716",
            "Item/Package": "Item",
            "Description": "ORT BUR OVAL 5.5 X 10MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $150.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $105.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10077",
            "Item/Package": "Item",
            "Description": "ORT BLADE PREC SAW THIN 11.5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $150.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $105.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10312",
            "Item/Package": "Item",
            "Description": "CAUTERY PEN W/SMOKE EVAC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $151.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $105.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6624",
            "Item/Package": "Item",
            "Description": "LAP ELECTRO LUBE SOL.",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $152.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $107.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7423",
            "Item/Package": "Item",
            "Description": "EYE SILICONE I/A HANDPIECE 45D",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $153.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $107.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7586",
            "Item/Package": "Item",
            "Description": "ENDO NEEDLE INJ FORCE MAX 5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $155.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $109.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5979",
            "Item/Package": "Item",
            "Description": "ORT ARTHREX CANNULA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $156.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $109.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6562",
            "Item/Package": "Item",
            "Description": "ORT ARTHREX CANNULA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $156.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $109.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10569",
            "Item/Package": "Item",
            "Description": "PAIN SYNCHROMED CATH PORT KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $156.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $109.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10777",
            "Item/Package": "Item",
            "Description": "DAVINCI REDUCER 12 - 8 MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $156.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $109.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6266",
            "Item/Package": "Item",
            "Description": "CYSTO CATH SIMPLASTIC 3WAY 24F",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $156.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $109.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "492",
            "Item/Package": "Item",
            "Description": "ENT BLADE MYRING V MUELLER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $158.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $111.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10971",
            "Item/Package": "Item",
            "Description": "CYSTO FOLLOWER HEYMAN 12FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $159.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $111.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11175",
            "Item/Package": "Item",
            "Description": "CYSTO FOLLOWER HEYMAN 14FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $159.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $111.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11176",
            "Item/Package": "Item",
            "Description": "CYSTO FOLLOWER HEYMAN 16FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $159.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $111.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11177",
            "Item/Package": "Item",
            "Description": "CYSTO FOLLOWER HEYMAN 18FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $159.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $111.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10970",
            "Item/Package": "Item",
            "Description": "CYSTO FOLLOWER HEYMAN 10FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $159.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $111.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11895",
            "Item/Package": "Item",
            "Description": "DAVINCI STRATAFIX PDS 0 23CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $160.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $112.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8327",
            "Item/Package": "Item",
            "Description": "DAVINCI VLOC 180 2/0 GR9 GS21",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $160.45 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $112.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10145",
            "Item/Package": "Item",
            "Description": "SUT GORTEX CV-0 THX-26",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $161.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $112.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3316",
            "Item/Package": "Item",
            "Description": "EYE KNIFE SLIT 2.4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $162.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $113.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "511",
            "Item/Package": "Item",
            "Description": "PACK SHOULDER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $162.31 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $113.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2512",
            "Item/Package": "Item",
            "Description": "CATHETER HYSTEROSALPINGOGRAM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $163.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $114.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10088",
            "Item/Package": "Item",
            "Description": "ORT BUR ROUND CARBIDE 4.0MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $164.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $115.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7132",
            "Item/Package": "Item",
            "Description": "TRAY EPIDURAL CATH KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $164.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $115.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3409",
            "Item/Package": "Item",
            "Description": "LAP IRRIGATOR HYDROSURG XTREME",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $165.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $115.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10085",
            "Item/Package": "Item",
            "Description": "ORT BUR SIDE CUTTING 2.1MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $165.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $115.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6045",
            "Item/Package": "Item",
            "Description": "FACIAL WRAP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $165.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $116.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5379",
            "Item/Package": "Item",
            "Description": "ORT BLADE RECIP DBL OFFSET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $166.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $116.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11186",
            "Item/Package": "Item",
            "Description": "DRAPE MICROSCOPE FOR ZEISS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $168.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $117.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3483",
            "Item/Package": "Item",
            "Description": "LAP SCISSOR CURVED 5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $168.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $118.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8646",
            "Item/Package": "Item",
            "Description": "DAVINCI VLOC NONABS OBL GS-21",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $173.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $121.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3233",
            "Item/Package": "Item",
            "Description": "LAP CLOSURE SYS TROCAR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $174.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $122.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3662",
            "Item/Package": "Item",
            "Description": "CYSTO GLIDEWIRE .035 STR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $177.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $124.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8255",
            "Item/Package": "Item",
            "Description": "DAVINCI SUCTION IRRIGATOR 5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $177.94 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $124.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7135",
            "Item/Package": "Item",
            "Description": "ORT K-WIRE 1.60MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $180.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $126.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5707",
            "Item/Package": "Item",
            "Description": "LAP TROCAR 12X150MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $181.06 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $126.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5763",
            "Item/Package": "Item",
            "Description": "LAP TROCAR 11MMX100 MM FIOS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $181.06 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $126.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10089",
            "Item/Package": "Item",
            "Description": "ORT BUR OVAL CARBIDE 4.0MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $182.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $127.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10084",
            "Item/Package": "Item",
            "Description": "ORT BUR CARBIDE ROUND 3.0MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $184.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $129.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10389",
            "Item/Package": "Item",
            "Description": "SUT GORTEX CV-2 (USP 0) 48\"",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $185.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $129.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "124",
            "Item/Package": "Item",
            "Description": "ENDO ALLIANCE INFLAT SYRNG DEV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $187.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $131.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8203",
            "Item/Package": "Item",
            "Description": "DAVINCI OBTUR BLADELESS 8MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $187.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $131.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8291",
            "Item/Package": "Item",
            "Description": "DAVINCI OBTUR BLADELESS LG 8M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $187.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $131.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10240",
            "Item/Package": "Item",
            "Description": "DAVINCI STRATAFIX PDS2-0 15CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $187.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $131.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5412",
            "Item/Package": "Item",
            "Description": "ORT BLADE W/ MOUNT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $193.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $135.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2649",
            "Item/Package": "Item",
            "Description": "CYSTO GLIDEWIRE .035 ANG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $193.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $135.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "531",
            "Item/Package": "Item",
            "Description": "ENT THERMASPLINT KIT MEDIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $194.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $136.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7431",
            "Item/Package": "Item",
            "Description": "ORT GUIDEWIRE NONTHD 2X250",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $199.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $139.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7936",
            "Item/Package": "Item",
            "Description": "CYSTO NEEDLE TIP 27 G",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $202.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $141.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10573",
            "Item/Package": "Item",
            "Description": "ORT PT KIT HANA & PRO FX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $208.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $146.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2885",
            "Item/Package": "Item",
            "Description": "LAP CATHETER CHOLANGIOGRAM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $210.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $147.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5131",
            "Item/Package": "Item",
            "Description": "LAP FORCE TRIVERSE ES DEVICE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $211.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $147.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11474",
            "Item/Package": "Item",
            "Description": "ORT PIN STEINMAN 1/8X9\"",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $212.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $148.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81591",
            "Item/Package": "Item",
            "Description": "PIGMENT ST MICRO SANDSTONE 3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $212.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $148.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5312",
            "Item/Package": "Item",
            "Description": "ORT INTEGRA SCRW 4.0MM CAN42MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $215.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $150.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8197",
            "Item/Package": "Item",
            "Description": "LAP HEMOLOK CLIP EX- LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $216.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $151.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7205",
            "Item/Package": "Item",
            "Description": "ORT ARTHREX FINGER  SHIELD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $218.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $152.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9933",
            "Item/Package": "Item",
            "Description": "ORT ARTHREX SUTURE TAPE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $218.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $152.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3638",
            "Item/Package": "Item",
            "Description": "CYSTO NEEDLE BIOPSY 18G X 20CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $218.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $153.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3768",
            "Item/Package": "Item",
            "Description": "CYSTO GLIDEWIRE .025 STR. TIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $223.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $156.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8022",
            "Item/Package": "Item",
            "Description": "DRESSING AQUACEL AG HYDRO 3.5X",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $224.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $157.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5870",
            "Item/Package": "Item",
            "Description": "SPINE PIN DISTRACTOR STR.",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $224.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $157.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10160",
            "Item/Package": "Item",
            "Description": "ORT CEMENT HOOK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $224.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $157.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10701",
            "Item/Package": "Item",
            "Description": "SPINE CSPAR DSTRCTION PIN 12MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $224.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $157.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8196",
            "Item/Package": "Item",
            "Description": "LAP HEMOLOK CLIP MED-LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $225.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $158.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6941",
            "Item/Package": "Item",
            "Description": "LAP HEMOLOK CLIP LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $226.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $158.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6993",
            "Item/Package": "Item",
            "Description": "CYSTO DILATORS URETERAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $230.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $161.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9935",
            "Item/Package": "Item",
            "Description": "MAMMARY SUPPORT B2-3032-H",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $235.37 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $164.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10590",
            "Item/Package": "Item",
            "Description": "MAMMARY SUPPORT B2-5052-H",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $235.37 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $164.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "846",
            "Item/Package": "Item",
            "Description": "RAD NEEDLE LOC HAWKINS 10.0CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $237.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $166.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2763",
            "Item/Package": "Item",
            "Description": "ENDO SPOT MARKER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $237.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $166.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6323",
            "Item/Package": "Item",
            "Description": "SPINE HARNESS CERVICAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $240.03 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $168.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5629",
            "Item/Package": "Item",
            "Description": "BLADE DERMATONE DISP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $240.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $168.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3141",
            "Item/Package": "Item",
            "Description": "MAMMARY SUPPORT B2-3436-H",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $241.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $169.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9611",
            "Item/Package": "Item",
            "Description": "CYSTO NEEDLE BIOPSY 18G X 25CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $241.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $169.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3441",
            "Item/Package": "Item",
            "Description": "ORT GUIDEWIRE 1.1MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $241.93 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $169.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3160",
            "Item/Package": "Item",
            "Description": "MAMMARY SUPPORT B2-4244",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $242.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $169.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2089",
            "Item/Package": "Item",
            "Description": "MAMMARY SUPPORT B2-3840-H",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $242.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $169.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7989",
            "Item/Package": "Item",
            "Description": "MAMMARY SUPPORT B2-4648",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $242.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $169.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4037",
            "Item/Package": "Item",
            "Description": "ORT BARREL BUR 4.0MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $243.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $170.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7374",
            "Item/Package": "Item",
            "Description": "VASC ACCESS V-STICK SET 4 FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $243.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $170.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3634",
            "Item/Package": "Item",
            "Description": "LAP ENDOLOOP PDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $245.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $171.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5295",
            "Item/Package": "Item",
            "Description": "ORT BLADE SAGITTAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $245.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $172.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4034",
            "Item/Package": "Item",
            "Description": "ORT BLADE RESECTOR 5.5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $253.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $177.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4035",
            "Item/Package": "Item",
            "Description": "ORT BLADE AGRESSIVE PLUS 4.0MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $253.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $177.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4036",
            "Item/Package": "Item",
            "Description": "ORT BLADE TOMCAT 5.0MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $253.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $177.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4038",
            "Item/Package": "Item",
            "Description": "ORT BARREL BUR 5.5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $253.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $177.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5780",
            "Item/Package": "Item",
            "Description": "ORT BLADE AGRESSIVE PLUS 5.0MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $253.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $177.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6766",
            "Item/Package": "Item",
            "Description": "ORT BLADE AGRESS PL 4.5MM ANG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $253.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $177.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4888",
            "Item/Package": "Item",
            "Description": "DRAPE FLUID WARMER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $258.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $181.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4047",
            "Item/Package": "Item",
            "Description": "LMAC ANES SUPPLIES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $259.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $181.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6860",
            "Item/Package": "Item",
            "Description": "SUTURE ETHILON 4-0 CLEAR MONO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $260.02 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $182.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11587",
            "Item/Package": "Item",
            "Description": "DRESSING AQUACEL AG 3.5X12",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $260.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $182.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10387",
            "Item/Package": "Item",
            "Description": "SPINE SURG TABLE PT CARE KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $263.78 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $184.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5731",
            "Item/Package": "Item",
            "Description": "IRRIGATION SET FLUID WARMING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $263.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $184.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7512",
            "Item/Package": "Item",
            "Description": "SUCTION IRRIGATOR STRYKERFLOW",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $264.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $184.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1194",
            "Item/Package": "Item",
            "Description": "HEMOSTATIC SURGICEL 2 X 3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $267.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $187.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6144",
            "Item/Package": "Item",
            "Description": "STAPLER SKIN INSORB 30",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $270.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $189.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4045",
            "Item/Package": "Item",
            "Description": "REGIONAL ANES SUPPLIES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $274.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $192.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "422",
            "Item/Package": "Item",
            "Description": "ENT SPLINT DOYLEII NASAL SEPTL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $277.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $194.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "913",
            "Item/Package": "Item",
            "Description": "ORT GUIDEWIRE THRD 1.11MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $279.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $195.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5141",
            "Item/Package": "Item",
            "Description": "MAMMARY SIZER SZHP68 XXX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $280.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $196.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5273",
            "Item/Package": "Item",
            "Description": "MAMMARY SIZER SZ68 XXX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $280.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $196.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5601",
            "Item/Package": "Item",
            "Description": "MAMMARY SIZER SALINE HP 190CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $280.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $196.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5603",
            "Item/Package": "Item",
            "Description": "MAMMARY SIZER SALINE HP 270CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $280.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $196.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5604",
            "Item/Package": "Item",
            "Description": "MAMMARY SIZER SALINE HP 290CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $280.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $196.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5605",
            "Item/Package": "Item",
            "Description": "MAMMARY SIZER SALINE HP 310CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $280.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $196.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5606",
            "Item/Package": "Item",
            "Description": "MAMMARY SIZER SALINE HP 330CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $280.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $196.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5607",
            "Item/Package": "Item",
            "Description": "MAMMARY SIZER SALINE HP 380CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $280.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $196.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5608",
            "Item/Package": "Item",
            "Description": "MAMMARY SIZER SALINE HP 420CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $280.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $196.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5609",
            "Item/Package": "Item",
            "Description": "MAMMARY SIZER SALINE HP 500CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $280.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $196.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5610",
            "Item/Package": "Item",
            "Description": "MAMMARY SIZER SALINE HP 630CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $280.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $196.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5702",
            "Item/Package": "Item",
            "Description": "MAM SIZER 351-XXXSZ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $280.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $196.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8390",
            "Item/Package": "Item",
            "Description": "MAMMARY SIZER SALINE MP 275CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $280.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $196.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8758",
            "Item/Package": "Item",
            "Description": "MAMMARY SIZER SALINE MP 350CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $280.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $196.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4889",
            "Item/Package": "Item",
            "Description": "TRAY MULTI-LUMEN CVC KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $286.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $200.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3140",
            "Item/Package": "Item",
            "Description": "SUPPORT COMPRESSION VEST MED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $288.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $202.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8075",
            "Item/Package": "Item",
            "Description": "PACK HAND CUSTOM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $289.94 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $202.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "980",
            "Item/Package": "Item",
            "Description": "ORT TUBING IRRIGATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $290.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $203.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4046",
            "Item/Package": "Item",
            "Description": "GEN ANES SUPPLIES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $291.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $204.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "940",
            "Item/Package": "Item",
            "Description": "ORT ABD PILLOW MEDIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $293.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $205.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6093",
            "Item/Package": "Item",
            "Description": "ORT CEMENT MIXEVAC 3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $296.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $207.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5990",
            "Item/Package": "Item",
            "Description": "ORT ARTX TRACTION ARM SLEEVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $299.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $209.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7671",
            "Item/Package": "Item",
            "Description": "APPLICATOR SYRG FAN TIP 12MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $302.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $211.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5476",
            "Item/Package": "Item",
            "Description": "ORT BLADE SAGITTAL HD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $305.40 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $213.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12222",
            "Item/Package": "Item",
            "Description": "ORT BLADE SAGITAL PERFORMANCE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $305.93 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $214.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3994",
            "Item/Package": "Item",
            "Description": "LAP LINEAR RELOAD 4X3.5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $306.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $214.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "473",
            "Item/Package": "Item",
            "Description": "PACK KNEE ARTHROSCOPY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $307.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $214.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "418",
            "Item/Package": "Item",
            "Description": "ENT SPLINT DENVER SMALL/MED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $307.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $215.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "420",
            "Item/Package": "Item",
            "Description": "ENT SPLINT DENVER LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $307.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $215.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5493",
            "Item/Package": "Item",
            "Description": "ORT BLADE SAGITTAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $308.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $216.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4897",
            "Item/Package": "Item",
            "Description": "ORT ARTHREX TIGERTAPE 2MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $312.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $218.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3955",
            "Item/Package": "Item",
            "Description": "GYN RUMI TIP BLUE 6.7MMX8CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $314.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $219.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3957",
            "Item/Package": "Item",
            "Description": "GYN RUMI TIP WHITE 6.7MM X 6CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $314.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $219.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3958",
            "Item/Package": "Item",
            "Description": "GYN RUMI TIP GREEN 6.7MMX10CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $314.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $219.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3959",
            "Item/Package": "Item",
            "Description": "GYN RUMI TIP LAV 5.1MMX6CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $314.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $219.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7191",
            "Item/Package": "Item",
            "Description": "GYN RUMI TIP ORANGE 6.7MMX6CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $314.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $219.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11658",
            "Item/Package": "Item",
            "Description": "SPINE SURG TABLE PRONEVIEW DBL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $314.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $220.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7185",
            "Item/Package": "Item",
            "Description": "SPINE BOW FRAME COVER KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $317.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $222.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1015",
            "Item/Package": "Item",
            "Description": "ORT SHLDER STABILIZATION KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $321.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $224.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3723",
            "Item/Package": "Item",
            "Description": "ORT ULTRA SLING MEDIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $321.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $225.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3724",
            "Item/Package": "Item",
            "Description": "ORT ULTRA SLING LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $322.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $226.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6664",
            "Item/Package": "Item",
            "Description": "CYSTO GUIDEWIRE AMPLATZ 7CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $323.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $226.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "467",
            "Item/Package": "Item",
            "Description": "RETRIEVE HOFFEE SUTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $324.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $227.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8199",
            "Item/Package": "Item",
            "Description": "DAVINCI DRAPE INSTRUMENT ARM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $324.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $227.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2866",
            "Item/Package": "Item",
            "Description": "CYSTO CUTTING LOOP 24FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $338.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $237.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11436",
            "Item/Package": "Item",
            "Description": "DRAPE C-ARMOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $339.71 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $237.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2438",
            "Item/Package": "Item",
            "Description": "DRAIN TLS SURGICAL SYSTEM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $344.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $241.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2867",
            "Item/Package": "Item",
            "Description": "CYSTO CUTTING LOOP 26FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $345.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $242.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5263",
            "Item/Package": "Item",
            "Description": "LAP ENDOSTITCH  0 VIOLET ES9",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $349.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $244.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8992",
            "Item/Package": "Item",
            "Description": "APPLICATOR ENDOSCOPIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $351.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $245.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6767",
            "Item/Package": "Item",
            "Description": "CYSTO NEEDLE TIP 27 G W/SHEALT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $360.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $252.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4022",
            "Item/Package": "Item",
            "Description": "MAMMARY SUPPORT BR34-36",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $362.71 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $253.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8016",
            "Item/Package": "Item",
            "Description": "COMPRESSION SUPPORT VEST SHORT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $365.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $255.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11736",
            "Item/Package": "Item",
            "Description": "SUPPORT RECOVERY VEST SHORT SM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $365.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $255.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3894",
            "Item/Package": "Item",
            "Description": "MAMMARY SUPPORT BR38-40",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $367.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $257.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4935",
            "Item/Package": "Item",
            "Description": "MAMMARY SUPPORT BR46-48",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $367.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $257.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3862",
            "Item/Package": "Item",
            "Description": "MAMMARY SUPPORT BR42-44",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $367.71 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $257.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3303",
            "Item/Package": "Item",
            "Description": "LAP TISSUE RETRIEVAL SYS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "558",
            "Item/Package": "Item",
            "Description": "ENT STIMULATORS NERVE XOMED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $386.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $270.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3877",
            "Item/Package": "Item",
            "Description": "EYE TIP KELMAN 30D 0.9 MINI-OH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $393.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $275.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2746",
            "Item/Package": "Item",
            "Description": "EYE VISION BLUE 0.6% TRYPAN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $401.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $281.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "786",
            "Item/Package": "Item",
            "Description": "LAP SCISSOR NU-TIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $402.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $281.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3219",
            "Item/Package": "Item",
            "Description": "ENDO HEMOSTASIS CLIPS 11MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $405.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $284.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9134",
            "Item/Package": "Item",
            "Description": "SYS WOUND DEBRID IRRISEPT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $418.87 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $293.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2983",
            "Item/Package": "Item",
            "Description": "PAIN CATHETER EPIDURAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $420.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $294.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6037",
            "Item/Package": "Item",
            "Description": "GIRDLE MIDTHIGH POWERKNIT LRG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $424.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $297.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6038",
            "Item/Package": "Item",
            "Description": "GIRDLE MIDTHIGH SATIN X-LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $424.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $297.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3208",
            "Item/Package": "Item",
            "Description": "ORT GUIDEWIRE 2.8MM THREADED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $429.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $300.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3721",
            "Item/Package": "Item",
            "Description": "MAMMARY COMPRESSION VEST BEIGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $438.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $306.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8074",
            "Item/Package": "Item",
            "Description": "PACK SHOULDER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $441.06 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $308.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9748",
            "Item/Package": "Item",
            "Description": "GIRDLE ABOVE KNEE BEIGE LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $446.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $312.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10835",
            "Item/Package": "Item",
            "Description": "GIRDLE ABOVE KNEE BEIGE MEDIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $446.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $312.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11648",
            "Item/Package": "Item",
            "Description": "KIT LAPAROSCOPY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $452.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $316.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5091",
            "Item/Package": "Item",
            "Description": "LAP LINEAR RELOAD 75MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $454.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $318.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6039",
            "Item/Package": "Item",
            "Description": "GIRDLE MIDTHIGH SATIN XX-LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $455.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $319.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3960",
            "Item/Package": "Item",
            "Description": "GYN OCCLUDER COLPO PNEUMO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $466.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $326.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8716",
            "Item/Package": "Item",
            "Description": "ORT BLADE PATELLA REAMER 38MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $468.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $327.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8717",
            "Item/Package": "Item",
            "Description": "ORT BLADE PATELLA REAMER 41MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $468.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $327.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8718",
            "Item/Package": "Item",
            "Description": "ORT BLADE PATELLA REAMER 46MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $468.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $327.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8729",
            "Item/Package": "Item",
            "Description": "ORT BLADE PATELLA REAMER 51MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $468.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $327.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10883",
            "Item/Package": "Item",
            "Description": "LAP TISSUE RETRIEVAL SYS 8MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $468.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $327.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8369",
            "Item/Package": "Item",
            "Description": "ADHESIVE SKIN DERMABOND PRINEO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $483.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $338.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11386",
            "Item/Package": "Item",
            "Description": "ENT SINU FOAM SINUS PACKING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $485.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $339.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3928",
            "Item/Package": "Item",
            "Description": "HEMOSTATIC SURGICEL 4 X 8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $488.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $342.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10282",
            "Item/Package": "Item",
            "Description": "ELEVIEW AMPULE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $505.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $354.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5298",
            "Item/Package": "Item",
            "Description": "ORT CEMENT MIXING BOWL 180GM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $507.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $355.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3992",
            "Item/Package": "Item",
            "Description": "LAP LINEAR RELOAD THICK 3X4.5M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $508.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $355.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7932",
            "Item/Package": "Item",
            "Description": "TRAY PARACENTESIS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $518.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $363.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3328",
            "Item/Package": "Item",
            "Description": "ENDO NET ROTH RETRIEVAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $524.45 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $367.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5430",
            "Item/Package": "Item",
            "Description": "ORT CEMENT MIXING KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $525.45 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $367.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "765",
            "Item/Package": "Item",
            "Description": "LAP CLIP APPLIER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $527.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $369.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2020",
            "Item/Package": "Item",
            "Description": "ENT PK MEROGEL DRSG/STENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $539.15 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $377.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2456",
            "Item/Package": "Item",
            "Description": "LAP CLIP APPLIER LRG 420",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $548.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $383.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5630",
            "Item/Package": "Item",
            "Description": "HEMOSTATIC POWDER ARISTA 1GM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $558.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $391.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6500",
            "Item/Package": "Item",
            "Description": "CYSTO SENSOR DUAL FLEX STR.",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $564.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $395.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3991",
            "Item/Package": "Item",
            "Description": "LAP LINEAR STAPLER 4X3.5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $570.16 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $399.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2940",
            "Item/Package": "Item",
            "Description": "ENDO PEG PONSKY PULL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $577.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $404.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2868",
            "Item/Package": "Item",
            "Description": "CYSTO VAPORTRODE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $579.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $405.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9711",
            "Item/Package": "Item",
            "Description": "RAD DRAIN CATH SKATER 6X20FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $581.94 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $407.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10672",
            "Item/Package": "Item",
            "Description": "PAIN TUN-L-XL/24 MINI KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $582.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $408.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2578",
            "Item/Package": "Item",
            "Description": "ORT DRILL BIT 3.5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $587.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $410.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6564",
            "Item/Package": "Item",
            "Description": "CYSTO SHEATH/DILATR 8/10 SET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $591.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $414.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7787",
            "Item/Package": "Item",
            "Description": "GYN RUMI CUP 3.0CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $593.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $415.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7788",
            "Item/Package": "Item",
            "Description": "GYN RUMI CUP 3.5CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $593.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $415.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5720",
            "Item/Package": "Item",
            "Description": "SPINE DEVICE BONE BIOPSY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $612.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $428.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8066",
            "Item/Package": "Item",
            "Description": "ORT BUR EGG ELITE 5.0MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $613.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $429.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6716",
            "Item/Package": "Item",
            "Description": "LAP TISSUE RETRIEVAL SYS 15MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $613.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $429.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81733",
            "Item/Package": "Item",
            "Description": "MISC POD SUPPLY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $614.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $429.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7541",
            "Item/Package": "Item",
            "Description": "GYN DELINEATOR ADVINCULA 4.0",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $616.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $431.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7542",
            "Item/Package": "Item",
            "Description": "GYN DELINEATOR ADVINCULA 3.5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $616.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $431.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8396",
            "Item/Package": "Item",
            "Description": "GYN DELINEATOR ADVINCULA 3.0",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $616.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $431.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5449",
            "Item/Package": "Item",
            "Description": "CYSTO UROPASS URETERAL SHEATH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $618.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $432.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2140",
            "Item/Package": "Item",
            "Description": "ORT DRILL BIT 2.5 MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $621.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $435.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11331",
            "Item/Package": "Item",
            "Description": "CLOSURE ZIPLINE SKIN 24CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $621.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $435.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8065",
            "Item/Package": "Item",
            "Description": "ORT BUR EGG ELITE 4.0MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $628.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $440.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5652",
            "Item/Package": "Item",
            "Description": "ORT PREP KIT FEM BONE CEMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $633.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $443.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7444",
            "Item/Package": "Item",
            "Description": "LAP ENDOSTITCH  V LOC 2-0 8 LP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $636.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $445.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8382",
            "Item/Package": "Item",
            "Description": "HEMOSTATIC SURGICEL SNOW 2 X 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $640.89 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $448.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5294",
            "Item/Package": "Item",
            "Description": "ORT CBCII",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $644.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $451.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3272",
            "Item/Package": "Item",
            "Description": "CYSTO ELECTRODE 2FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $644.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $451.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10091",
            "Item/Package": "Item",
            "Description": "ORT RASP SM TEAR CROSS CUT11X5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $655.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $458.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5718",
            "Item/Package": "Item",
            "Description": "SPINE SYRINGE INFLATION  XPAND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $656.16 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $459.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7420",
            "Item/Package": "Item",
            "Description": "LAP CLOSURE SYS SUT PASS 15MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $664.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $465.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8648",
            "Item/Package": "Item",
            "Description": "CRASH CART",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $665.68 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $465.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10452",
            "Item/Package": "Item",
            "Description": "ORT BUR ROUND FLUTED 5.0MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $713.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $499.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8252",
            "Item/Package": "Item",
            "Description": "DAVINCI DISSECTOR MARYLAND 5M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $713.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $499.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8256",
            "Item/Package": "Item",
            "Description": "DAVINCI SCISSORS CVD 5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $713.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $499.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11649",
            "Item/Package": "Item",
            "Description": "KIT LAPAROSCOPY GYN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $720.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $504.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11114",
            "Item/Package": "Item",
            "Description": "ORT RASP METAL CUT 3.2X18.3MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $722.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $505.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3182",
            "Item/Package": "Item",
            "Description": "ORT BLADE TRIANGLE INSTRATEK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $742.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $519.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5098",
            "Item/Package": "Item",
            "Description": "ENT PROBE PRASS MONOPOLAR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $748.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $523.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3065",
            "Item/Package": "Item",
            "Description": "CYSTO COLD KNIFE STR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $748.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $523.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7857",
            "Item/Package": "Item",
            "Description": "LAP CLIP APPLIER 5MM HEMOLOK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $748.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $523.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11479",
            "Item/Package": "Item",
            "Description": "ENDO HEMOSTASIS CLIPS 16MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $748.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $523.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10453",
            "Item/Package": "Item",
            "Description": "ORT BUR PRECISION NEURO 3.0MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $757.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $530.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10518",
            "Item/Package": "Item",
            "Description": "ORT PROTRACTR MD INCISION 5-9C",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $763.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $534.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80395",
            "Item/Package": "Item",
            "Description": "1.6MM KWIRE 150MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $764.37 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $535.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10150",
            "Item/Package": "Item",
            "Description": "RETRACTOR LONESTAR SYS KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $766.01 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $536.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5113",
            "Item/Package": "Item",
            "Description": "EYE MALYUGIN RING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $766.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $536.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6768",
            "Item/Package": "Item",
            "Description": "HEMOSTAT SURGIFLO MATRIX WO TH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $786.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $550.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5092",
            "Item/Package": "Item",
            "Description": "LAP LINEAR CUTTER 75MM BLUE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $786.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $550.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3880",
            "Item/Package": "Item",
            "Description": "EYE TUBING INTREPID",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $789.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $552.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7511",
            "Item/Package": "Item",
            "Description": "CYSTO BASKET HELICAL 4.5FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $805.01 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $563.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5982",
            "Item/Package": "Item",
            "Description": "ORT ARTHREX SUT LASSO L",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $805.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $564.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5983",
            "Item/Package": "Item",
            "Description": "ORT ARTHREX SUT LASSO R",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $805.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $564.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6197",
            "Item/Package": "Item",
            "Description": "ORT ARTHREX SUT LASSO 90D",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $805.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $564.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9014",
            "Item/Package": "Item",
            "Description": "DAVINCI ENDOWRIST STAPLER 45",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $805.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $564.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81730",
            "Item/Package": "Item",
            "Description": "MISC SPINE SUPPLY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $816.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $571.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7235",
            "Item/Package": "Item",
            "Description": "KIT SPINE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $825.13 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $577.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5900",
            "Item/Package": "Item",
            "Description": "LAP ECHELON 60 RELOAD BLUE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $826.62 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $578.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5261",
            "Item/Package": "Item",
            "Description": "LAP CLIP APPLIER 5MM LIGAMAX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $852.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $596.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9396",
            "Item/Package": "Item",
            "Description": "CYSTO ELECTRODE KNIFE ELITE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $856.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $599.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5485",
            "Item/Package": "Item",
            "Description": "LIGASURE PRECISE 1200",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $863.37 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $604.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "337",
            "Item/Package": "Item",
            "Description": "ENDO DILATOR ESOPH 12-13.5-15M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $873.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $611.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81732",
            "Item/Package": "Item",
            "Description": "MISC ORTHO SUPPLY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $886.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $620.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8826",
            "Item/Package": "Item",
            "Description": "SPINR CEMENT RESTRICTOR MED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $886.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $620.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5901",
            "Item/Package": "Item",
            "Description": "LAP ECHELON 60 RELOAD GREEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $892.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $624.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "339",
            "Item/Package": "Item",
            "Description": "ENDO DILATOR ESOPH 15-16.5-18M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $905.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $633.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "341",
            "Item/Package": "Item",
            "Description": "ENDO DILATOR ESOPH 18-19-20MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $914.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $640.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10530",
            "Item/Package": "Item",
            "Description": "ORT PIN XTRAFIX LG 5X250X85MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $932.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $652.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7140",
            "Item/Package": "Item",
            "Description": "LAP ECHELON 45 RELOAD GREEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $948.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $663.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3646",
            "Item/Package": "Item",
            "Description": "CYSTO CYTOLOGY BRUSH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $952.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $666.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6579",
            "Item/Package": "Item",
            "Description": "CYSTO SHEATH URETERAL 12F 55CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $972.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $680.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10424",
            "Item/Package": "Item",
            "Description": "CYSTO SHEATH URETERAL 10.7X55",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $972.73 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $680.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5123",
            "Item/Package": "Item",
            "Description": "ENT ELECTRODE SUBDERMAL 4 CH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $974.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $681.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7237",
            "Item/Package": "Item",
            "Description": "KIT TOTAL HIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $975.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $682.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5991",
            "Item/Package": "Item",
            "Description": "ORT ARTHREX NEEDLE SCORPION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $978.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $684.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5834",
            "Item/Package": "Item",
            "Description": "PAIN PUMP ON-Q  DUAL 5 CATH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $979.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $685.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7234",
            "Item/Package": "Item",
            "Description": "KIT TOTAL KNEE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $984.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $689.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6578",
            "Item/Package": "Item",
            "Description": "CYSTO SHEATH URETERAL 14F 28CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $997.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $698.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6577",
            "Item/Package": "Item",
            "Description": "CYSTO SHEATH URETERAL 14F 35CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $999.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $699.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6580",
            "Item/Package": "Item",
            "Description": "CYSTO SHEATH URETERAL 12F 35CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,004.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $703.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10422",
            "Item/Package": "Item",
            "Description": "CYSTO SHEATH URETERAL 10.7X28",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,005.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $704.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5722",
            "Item/Package": "Item",
            "Description": "SPINE BONE CEMENT AND MIXER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,007.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $705.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6581",
            "Item/Package": "Item",
            "Description": "CYSTO SHEATH URETERAL 12F 28CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,008.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $706.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10423",
            "Item/Package": "Item",
            "Description": "CYSTO SHEATH URETERAL 10.7X35",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,011.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $708.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6097",
            "Item/Package": "Item",
            "Description": "ORT MRI GUIDE PIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,017.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $712.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5631",
            "Item/Package": "Item",
            "Description": "HEMOSTATIC POWDER ARISTA 3GM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,024.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $717.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5400",
            "Item/Package": "Item",
            "Description": "PURSTRING CLOSURE DEVICE DISP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,024.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $717.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4017",
            "Item/Package": "Item",
            "Description": "ENDO DILATOR ESOPH  8-9-10MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,032.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $722.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9032",
            "Item/Package": "Item",
            "Description": "DAVINCI ENDOWRST RELOAD 45 BLU",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,036.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $725.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9033",
            "Item/Package": "Item",
            "Description": "DAVINCI ENDOWRST RELOAD 45 GRN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,036.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $725.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12002",
            "Item/Package": "Item",
            "Description": "DAVINCI ENDOWRST RELOAD 45 WHT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,036.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $725.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81728",
            "Item/Package": "Item",
            "Description": "MISC SPINE STIM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,060.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $742.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "335",
            "Item/Package": "Item",
            "Description": "ENDO DILATOR ESOPH 10-11-12MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,071.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $749.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8686",
            "Item/Package": "Item",
            "Description": "DAVINCI SCISSORS CVD 8MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,079.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $755.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7139",
            "Item/Package": "Item",
            "Description": "LAP ECHELON 45 RELOAD BLUE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,097.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $768.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8221",
            "Item/Package": "Item",
            "Description": "DAVINCI CAUTERY MONOPOLAR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,101.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $771.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10947",
            "Item/Package": "Item",
            "Description": "HEMOSTATIC POWDER SURGICEL 3GM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,105.16 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $773.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6273",
            "Item/Package": "Item",
            "Description": "ORT SUPER TURBOVAC 90",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,109.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $776.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "536",
            "Item/Package": "Item",
            "Description": "ENT BLADE XOMED TRICUT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,112.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $778.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8213",
            "Item/Package": "Item",
            "Description": "DAVINCI FORCEPS CADIERE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,122.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $785.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11669",
            "Item/Package": "Item",
            "Description": "ORT COBLATION FLOW 50 WAND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,122.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $785.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12215",
            "Item/Package": "Item",
            "Description": "ORT COBLATION FLOW 90 WAND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,122.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $785.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8208",
            "Item/Package": "Item",
            "Description": "DAVINCI GRASPER FENESTR DBL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,151.16 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $805.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8212",
            "Item/Package": "Item",
            "Description": "DAVINCI FORCEPS PROGRASP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,151.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $806.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "346",
            "Item/Package": "Item",
            "Description": "ENDO DILATOR PYLO/COLONIC 10MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,164.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $815.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "348",
            "Item/Package": "Item",
            "Description": "ENDO DILATOR PYLO/COLONIC 12MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,164.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $815.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "350",
            "Item/Package": "Item",
            "Description": "ENDO DILATOR PYLO/COLONIC 15MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,164.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $815.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8289",
            "Item/Package": "Item",
            "Description": "DAVINCI NEEDLE DRIVER LG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,172.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $820.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "344",
            "Item/Package": "Item",
            "Description": "ENDO DILATOR PYLO/COLONIC 18MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,190.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $833.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10519",
            "Item/Package": "Item",
            "Description": "ORT GUIDEWIRE BALL TIP 3X1000",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,224.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $857.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6094",
            "Item/Package": "Item",
            "Description": "ENDO PROBE ERBE STRAIGHT FIRE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,247.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $873.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8211",
            "Item/Package": "Item",
            "Description": "DAVINCI NEEDLE DRIVER MEGA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,266.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $886.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8290",
            "Item/Package": "Item",
            "Description": "DAVINCI FORCEPS TENACULUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,266.28 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $886.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8209",
            "Item/Package": "Item",
            "Description": "DAVINCI NEEDLE DRIVER MEGA CUT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,272.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $890.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "495",
            "Item/Package": "Item",
            "Description": "PACK EYE CUSTOM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,277.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $893.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11220",
            "Item/Package": "Item",
            "Description": "DAVINCI SUREFORM RELOAD 60 3.5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,323.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $926.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11221",
            "Item/Package": "Item",
            "Description": "DAVINCI SUREFORM RELOAD 60 4.3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,323.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $926.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3913",
            "Item/Package": "Item",
            "Description": "CYSTO LASER FIBER 200 DISP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,360.37 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $952.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8040",
            "Item/Package": "Item",
            "Description": "CYSTO LASER FIBER SIZE 400",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,363.40 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $954.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2870",
            "Item/Package": "Item",
            "Description": "CYSTO UROMAX ULTRA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,392.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $975.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6945",
            "Item/Package": "Item",
            "Description": "LAP STAPLER CVD CIRC 25MM ENDO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,415.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $991.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6946",
            "Item/Package": "Item",
            "Description": "LAP STAPLER CVD CIRC 29MM ENDO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,415.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $991.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6459",
            "Item/Package": "Item",
            "Description": "CYSTO BASKET SACRED HEART 1.5F",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,424.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $997.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "12109",
            "Item/Package": "Item",
            "Description": "ENDO BRAVO CF DELIV DEV CAP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,425.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $997.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6676",
            "Item/Package": "Item",
            "Description": "GYN TUBE COLPOTOMIZ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,433.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,003.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7881",
            "Item/Package": "Item",
            "Description": "GYN TUBE COLPOTOMIZ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,433.19 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,003.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2247",
            "Item/Package": "Item",
            "Description": "ENT COBLATOR REF. ULTRA 45",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,441.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,009.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6431",
            "Item/Package": "Item",
            "Description": "LAP CONTOUR RELOAD BL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,456.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,019.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6432",
            "Item/Package": "Item",
            "Description": "LAP CONTOUR RELOAD GRN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,456.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,019.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8205",
            "Item/Package": "Item",
            "Description": "DAVINCI SCISSORS CVD MONOPOLA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,468.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,028.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6992",
            "Item/Package": "Item",
            "Description": "CYSTO BASKET NGAGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,489.16 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,042.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8206",
            "Item/Package": "Item",
            "Description": "DAVINCI FORCEPS BIP MARYLAND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,498.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,048.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8215",
            "Item/Package": "Item",
            "Description": "DAVINCI SUCTION IRRIGATOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,525.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,067.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3047",
            "Item/Package": "Item",
            "Description": "ENT COBLATOR PRECISE MAX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,529.37 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,070.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8207",
            "Item/Package": "Item",
            "Description": "DAVINCI FORCEPS BIP FENESTR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,554.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,087.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5262",
            "Item/Package": "Item",
            "Description": "LAP ENDOSTITCH 10MM SUTURE DEV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,554.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,088.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8797",
            "Item/Package": "Item",
            "Description": "BLADE PEAK PLASMA 3.0S",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,566.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,096.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6644",
            "Item/Package": "Item",
            "Description": "SPINE DRAINAGE SYS.VENTR.",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,577.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,103.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5403",
            "Item/Package": "Item",
            "Description": "LAP STAPLER CVD CIRC 25MM PROX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,580.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,106.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5405",
            "Item/Package": "Item",
            "Description": "LAP STAPLER CRD CIRC 29MM PROX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,580.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,106.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6563",
            "Item/Package": "Item",
            "Description": "ORT ARTHREX SUT TAK 2.4 PEEK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,582.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,107.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3222",
            "Item/Package": "Item",
            "Description": "CYSTO GRASPING FORCEP BASKET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,590.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,113.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "738",
            "Item/Package": "Item",
            "Description": "BARRIER ADHSN INTERCEDE ABS3X4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,601.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,120.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8608",
            "Item/Package": "Item",
            "Description": "ENT TUBE NIM TRIVANTAGE 7MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,601.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,120.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7157",
            "Item/Package": "Item",
            "Description": "PAIN PROBE SIMPLICITY III",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,606.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,124.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9426",
            "Item/Package": "Item",
            "Description": "DRESSING PICO WOUND 4X12",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,619.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,133.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9427",
            "Item/Package": "Item",
            "Description": "DRESSING PICO WOUND 4X16",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,619.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,133.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6646",
            "Item/Package": "Item",
            "Description": "SPINE KIT LUMBAR ACCESSORY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,623.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,136.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2872",
            "Item/Package": "Item",
            "Description": "CYSTO BAGLEY 1.9 FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,633.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,143.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6063",
            "Item/Package": "Item",
            "Description": "SPINE MILL BLADE FINE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,650.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,155.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10338",
            "Item/Package": "Item",
            "Description": "GYN LOOP LINA BIPOLAR LG 5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,652.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,156.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5448",
            "Item/Package": "Item",
            "Description": "LAP ECHELONFLEX PDW VAS 45MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,656.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,159.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9044",
            "Item/Package": "Item",
            "Description": "CYSTO LASER FIBER 1000 DISP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,656.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,159.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9879",
            "Item/Package": "Item",
            "Description": "ENDO BRAVO PH CAPSULE DEVICE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,669.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,168.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10337",
            "Item/Package": "Item",
            "Description": "LAP STAPLER PROTACK 5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,677.11 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,173.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2873",
            "Item/Package": "Item",
            "Description": "CYSTO BASKET SEGURA FLAT WIRE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,682.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,177.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11035",
            "Item/Package": "Item",
            "Description": "CYSTO LASER FIBER EXCALIBUR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,713.13 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,199.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3968",
            "Item/Package": "Item",
            "Description": "LIGASURE ATLAS 37CM 10MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,746.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,222.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5866",
            "Item/Package": "Item",
            "Description": "LAP STAPLER ECHELON FLEX 60 AR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,751.44 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,226.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5719",
            "Item/Package": "Item",
            "Description": "SPINE INTRODUCER OSTEO BEVEL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,835.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,285.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6722",
            "Item/Package": "Item",
            "Description": "LAP ENSEAL TISSUE SEAL DEV CVD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,874.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,312.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2957",
            "Item/Package": "Item",
            "Description": "CYSTO STONE CONE 3FR 7MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,878.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,314.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8649",
            "Item/Package": "Item",
            "Description": "MISC SUPPLY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,891.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,323.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3660",
            "Item/Package": "Item",
            "Description": "CYSTO LASER FIBER DISP 550",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,911.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,337.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5646",
            "Item/Package": "Item",
            "Description": "LIGASURE BLUNT TIP 5MM 37CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,915.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,341.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2875",
            "Item/Package": "Item",
            "Description": "CYSTO ZEROTIP 1.9 FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,930.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,351.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11219",
            "Item/Package": "Item",
            "Description": "DAVINCI STAPLER SUREFORM 60",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,983.15 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,388.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6311",
            "Item/Package": "Item",
            "Description": "LIGASURE OPEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,007.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,405.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6377",
            "Item/Package": "Item",
            "Description": "LAP CUTTER CONTOUR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,064.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,445.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3421",
            "Item/Package": "Item",
            "Description": "CYSTO LASER FIBER 365",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,065.41 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,445.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2943",
            "Item/Package": "Item",
            "Description": "EYE CATHETER 2MM KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,076.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,453.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2980",
            "Item/Package": "Item",
            "Description": "EYE CATHETER 3MM KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,076.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,453.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10151",
            "Item/Package": "Item",
            "Description": "SUT CAPIO SLIM CAPTURNG DEVICE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,099.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,469.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7410",
            "Item/Package": "Item",
            "Description": "LAP ENSEAL X1 LARGE JAW",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,103.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,472.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7506",
            "Item/Package": "Item",
            "Description": "LAP STAPLER SECURESTRAP 25 CT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,111.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,478.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7721",
            "Item/Package": "Item",
            "Description": "CYSTO RESECTION LOOP MD 24FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,114.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,480.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3988",
            "Item/Package": "Item",
            "Description": "HARMONIC SCALPEL 36CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,116.51 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,481.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7574",
            "Item/Package": "Item",
            "Description": "CYSTO RESECTION LOOP LG 24FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,125.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,487.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5754",
            "Item/Package": "Item",
            "Description": "ENDO TEN SHOOTER LIGATOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,170.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,519.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9368",
            "Item/Package": "Item",
            "Description": "SHEAR FOCUS CVD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,172.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,521.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7629",
            "Item/Package": "Item",
            "Description": "CYSTO RESECTION LOOP BUTN 24FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,220.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,554.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7779",
            "Item/Package": "Item",
            "Description": "GYN MYOSURE HANDPIECE LITE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,245.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,571.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2889",
            "Item/Package": "Item",
            "Description": "CYSTO SHEATH / DILATOR KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,245.65 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,571.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7525",
            "Item/Package": "Item",
            "Description": "LAP ENSEAL ARTICULATING 5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,256.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,579.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8214",
            "Item/Package": "Item",
            "Description": "DAVINCI VESSEL SEALER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,339.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,637.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5849",
            "Item/Package": "Item",
            "Description": "LAP GELPORT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,347.98 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,643.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2916",
            "Item/Package": "Item",
            "Description": "CYSTO LASER FIBER 1000",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,363.16 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,654.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4003",
            "Item/Package": "Item",
            "Description": "LIGASURE IMPACT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,432.91 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,703.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3240",
            "Item/Package": "Item",
            "Description": "CYSTO PIRANHA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,444.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,711.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5742",
            "Item/Package": "Item",
            "Description": "SPINE BIOGLUE 5ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,765.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,936.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10863",
            "Item/Package": "Item",
            "Description": "SPINE ADV OSTEO INTRODUCER QC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,829.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,980.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2759",
            "Item/Package": "Item",
            "Description": "GYN NOVASURE HANDPIECE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3,201.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,241.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6785",
            "Item/Package": "Item",
            "Description": "GYN MYOSURE HANDPIECE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3,205.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,243.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9414",
            "Item/Package": "Item",
            "Description": "MINERVA HANDPIECE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3,494.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,446.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5721",
            "Item/Package": "Item",
            "Description": "SPINE BONE TAMP INFLATABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3,611.31 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,527.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9875",
            "Item/Package": "Item",
            "Description": "ENDO BARRX 90 RFA FOCAL CATH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3,956.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,769.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10641",
            "Item/Package": "Item",
            "Description": "SPINE KYPHON EXPRESS KIT 10/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10,650.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7,455.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5723",
            "Item/Package": "Item",
            "Description": "SPINE KIT THORACIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11,659.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8,161.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10053",
            "Item/Package": "Item",
            "Description": "EYE IOL AMO TECNIS ZCB00 18.0",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "276",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $690.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $483.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10055",
            "Item/Package": "Item",
            "Description": "EYE IOL AMO TECNIS ZCB00 19.5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "276",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $690.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $483.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10056",
            "Item/Package": "Item",
            "Description": "EYE IOL AMO TECNIS ZCB00 20.0",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "276",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $690.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $483.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10057",
            "Item/Package": "Item",
            "Description": "EYE IOL AMO TECNIS ZCB00 21.0",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "276",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $690.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $483.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2990",
            "Item/Package": "Item",
            "Description": "EYE IOL BAUSCH/LOMB LI61A0",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "276",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $863.37 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $604.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7147",
            "Item/Package": "Item",
            "Description": "EYE IOL BAUSCH/LOMB ENVIST MX6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "276",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $863.37 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $604.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8781",
            "Item/Package": "Item",
            "Description": "ORT SBI GUIDEWIRE 2.88MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10103",
            "Item/Package": "Item",
            "Description": "ORT PLATE LCP SUP CLAV 3.5 7HR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10104",
            "Item/Package": "Item",
            "Description": "ORT ARTHREX STAPLE COMP 20X20",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8848",
            "Item/Package": "Item",
            "Description": "CAP STAY SAFE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7974",
            "Item/Package": "Item",
            "Description": "OSTOMY CENTERPOINTLOCK 2PC 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7975",
            "Item/Package": "Item",
            "Description": "OSTOMY CENTERPOINTLOCK FLEXW",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $10.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "520",
            "Item/Package": "Item",
            "Description": "ENT TUBE MYRING SHEEHY CLR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $50.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $35.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9516",
            "Item/Package": "Item",
            "Description": "ENT TUBE COLLAR BUTTON SHEEHY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $50.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $35.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9638",
            "Item/Package": "Item",
            "Description": "GRAFT ALLODERM 9.6X19.3 THICK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "Q4116",
            " Charge Amount ": " $79.39 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $55.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11377",
            "Item/Package": "Item",
            "Description": "GRAFT ALLODERM 9.6X19.3 THICK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "Q4116",
            " Charge Amount ": " $84.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $59.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "450",
            "Item/Package": "Item",
            "Description": "ENT TUBE MYRING PAPARELLA 1.4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $119.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $83.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "479",
            "Item/Package": "Item",
            "Description": "ENT TUBE MYRING RICHARDS MOD T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $151.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $106.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10161",
            "Item/Package": "Item",
            "Description": "GRAFT FLEXHD PERF MD 11X20CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "Q4116",
            " Charge Amount ": " $153.94 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $107.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1906",
            "Item/Package": "Item",
            "Description": "ORT SCRW BIOSURE HA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $160.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $112.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80429",
            "Item/Package": "Item",
            "Description": "4MM TI CAN BN SCRW FT 10MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $173.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $121.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80434",
            "Item/Package": "Item",
            "Description": "4MM TI CAN BN SCRW FT 20MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $173.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $121.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "873",
            "Item/Package": "Item",
            "Description": "MESH MARLEX 1 X 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $173.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $121.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3270",
            "Item/Package": "Item",
            "Description": "ORT SCRW 4.5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $177.94 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $124.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9315",
            "Item/Package": "Item",
            "Description": "ORT SCRW CANC FT 4MM X 18MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $184.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $129.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9505",
            "Item/Package": "Item",
            "Description": "ORT SCRW CANC FT 4MMX20MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $184.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $129.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3418",
            "Item/Package": "Item",
            "Description": "ORT SCRW 3.5 CANN. ZIMMER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $196.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $137.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9207",
            "Item/Package": "Item",
            "Description": "ORT SCRW CORTEX SELFTAP 3.5X20",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $196.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $137.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80421",
            "Item/Package": "Item",
            "Description": "3.5MM TI CORTX SCRW SLF T 30MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $196.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $137.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9314",
            "Item/Package": "Item",
            "Description": "ORT SCRW CANC FT 4MM X 16MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $201.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $141.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80430",
            "Item/Package": "Item",
            "Description": "4MM TI CAN BN SCRW FT 12MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $209.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $146.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80431",
            "Item/Package": "Item",
            "Description": "4MM TI CAN BN SCRW FT 14MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $209.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $146.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80432",
            "Item/Package": "Item",
            "Description": "4MM TI CAN BN SCRW FT 16MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $209.77 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $146.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8849",
            "Item/Package": "Item",
            "Description": "CONNECTOR STAY SAFE LL EXTENSN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $217.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $152.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2136",
            "Item/Package": "Item",
            "Description": "ORT SCRW CANNULATED INTERF 6M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $224.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $157.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9284",
            "Item/Package": "Item",
            "Description": "ORT SCRW CORTEX SELFTAP 3.5X16",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $224.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $157.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9410",
            "Item/Package": "Item",
            "Description": "ORT SCRW CORTEX SELFTAP 3.5X22",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $224.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $157.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9504",
            "Item/Package": "Item",
            "Description": "ORT SCRW CORTEX SELFTAP 3.5X24",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $224.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $157.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9511",
            "Item/Package": "Item",
            "Description": "ORT SCRW CORTEX SELFTAP 3.5X18",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $224.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $157.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "1018",
            "Item/Package": "Item",
            "Description": "ORT WASHER 7MM/4.0 CORT SET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $229.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $160.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9430",
            "Item/Package": "Item",
            "Description": "ORT SCRW CANC FT 4MMX14MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $231.01 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $161.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "877",
            "Item/Package": "Item",
            "Description": "MESH MARLEX 3 X 6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $236.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $165.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "875",
            "Item/Package": "Item",
            "Description": "MESH MARLEX 2 X 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $256.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $179.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80130",
            "Item/Package": "Item",
            "Description": "4MM CORT SCRW SLF TAP 52MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $259.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $181.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9732",
            "Item/Package": "Item",
            "Description": "ORT SCRW CORTEX SELFTAP 3.5X38",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $262.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $183.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740",
            "Item/Package": "Item",
            "Description": "PORTA CATH INTRO KIT 6 FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $276.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $193.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9206",
            "Item/Package": "Item",
            "Description": "ORT SCRW CORTEX SELFTAP 3.5X14",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $280.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $196.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80412",
            "Item/Package": "Item",
            "Description": "3.5MM TI CORTX SCRW SLF T 12MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $305.93 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $214.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80413",
            "Item/Package": "Item",
            "Description": "3.5MM TI CORTX SCRW SLF T 14MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $305.93 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $214.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10764",
            "Item/Package": "Item",
            "Description": "ORT TJ BONE CEMENT BIOMET 1X40",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $330.40 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $231.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2661",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 7 X 28",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3649",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 4.5 X 24",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3650",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 4.5 X 26",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3651",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 4.5 X 28",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3652",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 6 X 22",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3653",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 6 X 24",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3654",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 6 X 26",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3655",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 6 X 28",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3663",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 6 X 20",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3722",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 7 X 24",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3836",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 7 X 22",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3920",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 7 X 26",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4004",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 8.5 X 24",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5301",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 7 X 20",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5591",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 8.5 X 26",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7146",
            "Item/Package": "Item",
            "Description": "CYSTO STENT 8.5 X 28",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80371",
            "Item/Package": "Item",
            "Description": "2.7MM CORTX SCRW SLF TAP 18MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80372",
            "Item/Package": "Item",
            "Description": "2.7MM CORTX SCRW SLF TAP 20MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $374.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $262.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5299",
            "Item/Package": "Item",
            "Description": "ORT TJ BONE CEMENT SPLX RDOPQ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $480.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $336.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6384",
            "Item/Package": "Item",
            "Description": "CYSTO STENT QUADRA COIL 6 FR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $493.23 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $345.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7872",
            "Item/Package": "Item",
            "Description": "CYSTO STENT URETERAL SFCL 6F24",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $499.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $349.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7873",
            "Item/Package": "Item",
            "Description": "CYSTO STENT URETERAL SFCL 6F26",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $499.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $349.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7874",
            "Item/Package": "Item",
            "Description": "CYSTO STENT URETERAL SFCL 6F28",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $499.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $349.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2903",
            "Item/Package": "Item",
            "Description": "ENT NASAL SEPTAL BUTTON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $530.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $371.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "872",
            "Item/Package": "Item",
            "Description": "MESH MARLEX 10 X 14",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $623.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $436.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3101",
            "Item/Package": "Item",
            "Description": "GYN FILSHIE CLIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $633.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $443.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81734",
            "Item/Package": "Item",
            "Description": "MISC SPINE STIM ANCHOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $642.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $449.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11187",
            "Item/Package": "Item",
            "Description": "CATH ARGYLE CRL PERIT 2CUFF 62",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $749.62 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $524.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881",
            "Item/Package": "Item",
            "Description": "MESH MARLEX PLUG SMALL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $815.02 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $570.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9068",
            "Item/Package": "Item",
            "Description": "ORT STAPLZER CARTRIDGE 16X25MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $826.82 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $578.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2836",
            "Item/Package": "Item",
            "Description": "MESH MARLEX PLUG MEDIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $832.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $582.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "879",
            "Item/Package": "Item",
            "Description": "MESH MARLEX PLUG LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $843.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $590.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7179",
            "Item/Package": "Item",
            "Description": "CATH CNTR VEN DBL LUMEN 5F PIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $930.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $651.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10778",
            "Item/Package": "Item",
            "Description": "ORT REFOBACIN BONE CEMENT 1X40",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $989.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $692.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10967",
            "Item/Package": "Item",
            "Description": "MESH PERFIX LITE PLUG XLG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,134.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $793.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7957",
            "Item/Package": "Item",
            "Description": "ORT TJ BONE CEMENT SPLX HVGENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,233.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $863.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81610",
            "Item/Package": "Item",
            "Description": "ORT EXTR TIP BRKN SCRW 3.5-5MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,237.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $866.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3589",
            "Item/Package": "Item",
            "Description": "ORT SCRW CANN CNTRSNK BIOMET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,249.01 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $874.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3172",
            "Item/Package": "Item",
            "Description": "BONE GRAFT CANCELL COARSE 15CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,272.03 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $890.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81720",
            "Item/Package": "Item",
            "Description": "MISC PODIATRY IMPLANTS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,317.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $922.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81611",
            "Item/Package": "Item",
            "Description": "ORT EXTR TIP BRKN SCRW 4.5-6MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,352.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $946.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81612",
            "Item/Package": "Item",
            "Description": "ORT EXTR TIP BRKN SCRW 5.5-7MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,352.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $946.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81613",
            "Item/Package": "Item",
            "Description": "ORT EXTR TIP BRKN SCRW 7-8MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,352.61 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $946.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80102",
            "Item/Package": "Item",
            "Description": "4MM CANN SCRW SHT THRD 40MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,384.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $969.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80105",
            "Item/Package": "Item",
            "Description": "4MM CANN SCRW SHT THRD 46MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,384.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $969.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80479",
            "Item/Package": "Item",
            "Description": "TI ONE THIRD TUB PLATE 10H 121",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,387.95 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $971.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81719",
            "Item/Package": "Item",
            "Description": "MISC PLASTIC IMPLANTS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,398.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $979.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5778",
            "Item/Package": "Item",
            "Description": "ORT PLATE SMALL FRAG 5H",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,413.63 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $989.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2241",
            "Item/Package": "Item",
            "Description": "MESH PHS LARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,425.62 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $997.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5300",
            "Item/Package": "Item",
            "Description": "ORT TJ BONE CEMENT SPLX TOBRA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,431.33 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,001.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5149",
            "Item/Package": "Item",
            "Description": "ORT PLATE SMALL FRAG 6H",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,435.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,004.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80104",
            "Item/Package": "Item",
            "Description": "4MM CANN SCRW SHT THRD 44MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,441.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,009.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5475",
            "Item/Package": "Item",
            "Description": "ORT STAPLE BARBED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,459.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,021.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5478",
            "Item/Package": "Item",
            "Description": "ORT STAPLE MEDIUM FIXATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,461.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,023.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2242",
            "Item/Package": "Item",
            "Description": "MESH PHS MEDIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,465.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,025.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2646",
            "Item/Package": "Item",
            "Description": "MESH PHS EXTENDED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,465.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,025.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6313",
            "Item/Package": "Item",
            "Description": "ORT ARTHREX ANCHOR BC VENTED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,491.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,044.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7107",
            "Item/Package": "Item",
            "Description": "ORT ARTX SUT ANCHOR 5.5X14MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,560.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,092.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81717",
            "Item/Package": "Item",
            "Description": "MISC IMPLANT OCULAR LENSE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,565.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,095.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8126",
            "Item/Package": "Item",
            "Description": "ORT SMFRAG TUBLR PLATE 6H/73MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,588.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,112.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7131",
            "Item/Package": "Item",
            "Description": "PORTA CATH PWR CLEARVUE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,611.62 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,128.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10044",
            "Item/Package": "Item",
            "Description": "ORT ARTX ANC B/C CRKSCW FT VNT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,629.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,140.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8840",
            "Item/Package": "Item",
            "Description": "MESH SYMBOTEX COMPOSITE 9CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,635.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,144.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "4945",
            "Item/Package": "Item",
            "Description": "ORT ARTX ANC MINI CRKSCRW 2.7",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,640.40 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,148.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81223",
            "Item/Package": "Item",
            "Description": "ORT ARTX ANC MINI CRKSCRW 2.2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,640.40 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,148.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81716",
            "Item/Package": "Item",
            "Description": "MISC IMPLANT BIOLOGIC MESH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,710.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,197.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81726",
            "Item/Package": "Item",
            "Description": "MISC SPINE STIM EXT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "C1883",
            " Charge Amount ": " $1,715.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,200.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80103",
            "Item/Package": "Item",
            "Description": "4MM CANN SCRW SHT THRD 42MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,730.35 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,211.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2887",
            "Item/Package": "Item",
            "Description": "MESH VENTRALEX SM PCH 1.7",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,737.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,216.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80172",
            "Item/Package": "Item",
            "Description": "7.3MM CANN SCRW LNG THRD 65MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,795.53 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,256.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81714",
            "Item/Package": "Item",
            "Description": "MISC IMPLANT SPINE/ COMPONENTS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,800.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,260.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6013",
            "Item/Package": "Item",
            "Description": "ORT ARTHREX ANCHOR SWLCK 5.5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,835.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,285.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6083",
            "Item/Package": "Item",
            "Description": "ORT ARTHREX ANCHOR SWLCK 4.75",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,835.92 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,285.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81721",
            "Item/Package": "Item",
            "Description": "MISC ORTHO IMPLANTS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,844.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,290.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80174",
            "Item/Package": "Item",
            "Description": "7.3MM CANN SCRW LNG THRD 75MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,868.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,307.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8535",
            "Item/Package": "Item",
            "Description": "TISSUE GORE BIOA FLAT 7 X 10",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,891.31 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,323.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7269",
            "Item/Package": "Item",
            "Description": "ORT TJ CABLE NON-BEADED 1.6MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,927.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,349.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7270",
            "Item/Package": "Item",
            "Description": "ORT TJ CABLE NON-BEADED 2.0MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,927.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,349.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8839",
            "Item/Package": "Item",
            "Description": "MESH SYMBOTEX COMPOSITE 12CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,949.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,364.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5744",
            "Item/Package": "Item",
            "Description": "SPINE DURAGEN 1 X 1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,088.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,461.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "80147",
            "Item/Package": "Item",
            "Description": "7.3MM CANN SCRW SHT THRD 50MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,097.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,468.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3207",
            "Item/Package": "Item",
            "Description": "MESH VENTRALEX MED PCH 2.5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,122.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,485.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5558",
            "Item/Package": "Item",
            "Description": "PORTA CATH PWR PAC LOW PROFILE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,162.25 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,513.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3466",
            "Item/Package": "Item",
            "Description": "MESH VENTRALEX LG PCH 3.2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,175.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,522.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9420",
            "Item/Package": "Item",
            "Description": "MESH GORE SYNECOR CIRC 12CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,228.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,559.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "3921",
            "Item/Package": "Item",
            "Description": "BONE GRAFT TRICORT BLK 2.0-3.3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,245.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,571.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5450",
            "Item/Package": "Item",
            "Description": "ORT BONE PUTTY DBX 2.5 CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,316.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,621.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8650",
            "Item/Package": "Item",
            "Description": "MISC IMPLANT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,357.13 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,649.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9419",
            "Item/Package": "Item",
            "Description": "MESH SYNECOR OVAL 10X15CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,445.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,711.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5873",
            "Item/Package": "Item",
            "Description": "MESH Y INTEPRO FGS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,676.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,873.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11482",
            "Item/Package": "Item",
            "Description": "SPINE DURASEAL SEALANT SYS 5ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,729.29 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,910.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10028",
            "Item/Package": "Item",
            "Description": "GRAFT AMNIOTIC MEMBRANE 2X2CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "V2790",
            " Charge Amount ": " $2,749.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,924.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9404",
            "Item/Package": "Item",
            "Description": "SLING LYNX MID URETHRAL SYSTEM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,842.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,989.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81713",
            "Item/Package": "Item",
            "Description": "MISC IMPLANT KNEE/HIP/SHOULDR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,869.76 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,008.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6779",
            "Item/Package": "Item",
            "Description": "SPINE DURAGEN 2 X 2 SUTURABLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,891.27 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,023.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81722",
            "Item/Package": "Item",
            "Description": "MISC UROLOGY IMPLANTS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3,976.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,783.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9742",
            "Item/Package": "Item",
            "Description": "MESH SYNECOR OVAL 15X20CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4,899.40 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3,429.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81723",
            "Item/Package": "Item",
            "Description": "MISC SPINE STIM LEAD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "C1778",
            " Charge Amount ": " $5,514.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3,859.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11112",
            "Item/Package": "Item",
            "Description": "EYE MICROSTENT HYDRUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5,991.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4,193.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11068",
            "Item/Package": "Item",
            "Description": "EYE STENT INJECT TRABEC MICRO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "L8612",
            " Charge Amount ": " $6,240.75 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4,368.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7805",
            "Item/Package": "Item",
            "Description": "ORT SUBCHONDROPLASTY KNEE KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8,071.37 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5,649.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81715",
            "Item/Package": "Item",
            "Description": "MISC IMPLANT PENILE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12,047.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8,432.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11568",
            "Item/Package": "Item",
            "Description": "BONE GRAFT INFUSE SMALL KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $12,664.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8,865.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "6824",
            "Item/Package": "Item",
            "Description": "BONE GRAFT INFUSE LARGE II KIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $19,670.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13,769.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81725",
            "Item/Package": "Item",
            "Description": "MISC SPINE STIM GEN NCHG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "C1767",
            " Charge Amount ": " $52,165.54 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $36,515.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "81724",
            "Item/Package": "Item",
            "Description": "MISC SPINE STIM GEN CHG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "278",
            "CPT/HCPCS/DRG": "C1820",
            " Charge Amount ": " $53,187.83 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $37,231.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "827050",
            "Item/Package": "Item",
            "Description": "FATS/LIPIDS FECES QUALITATIV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82705",
            " Charge Amount ": " $12.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "829620",
            "Item/Package": "Item",
            "Description": "GLUCOSE BLOOD TEST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82962",
            " Charge Amount ": " $20.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "850140",
            "Item/Package": "Item",
            "Description": "HEMATOCRIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "85014",
            " Charge Amount ": " $20.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "850180",
            "Item/Package": "Item",
            "Description": "HEMAGLOBIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "85018",
            " Charge Amount ": " $20.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "856520",
            "Item/Package": "Item",
            "Description": "SEDIMENT RATE ERYTHROCYTE AUTO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "85652",
            " Charge Amount ": " $20.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "841570",
            "Item/Package": "Item",
            "Description": "TOTAL PROTEIN OTHER SPECIMEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84157",
            " Charge Amount ": " $22.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "810010",
            "Item/Package": "Item",
            "Description": "AUTOM URINE DIP W MICRO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "81001",
            " Charge Amount ": " $23.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "841560",
            "Item/Package": "Item",
            "Description": "PROTEIN TTL EXCEP REFRAC URINE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84156",
            " Charge Amount ": " $23.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "891900",
            "Item/Package": "Item",
            "Description": "EOSINOPHIL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "89190",
            " Charge Amount ": " $23.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "841550",
            "Item/Package": "Item",
            "Description": "ASSAY PROTEIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84155",
            " Charge Amount ": " $24.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "856510",
            "Item/Package": "Item",
            "Description": "SED RATE, NON-AUTOMATED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "85651",
            " Charge Amount ": " $24.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $16.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "839860",
            "Item/Package": "Item",
            "Description": "PH BODY FLUID EXCEPT BLOOD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "83986",
            " Charge Amount ": " $25.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "364150",
            "Item/Package": "Item",
            "Description": "ROUTINE VENIPUNCTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "36415",
            " Charge Amount ": " $32.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $22.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "822470",
            "Item/Package": "Item",
            "Description": "BILIRUBIN TOTAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82247",
            " Charge Amount ": " $33.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "822480",
            "Item/Package": "Item",
            "Description": "BILIRUBIN DIRECT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82248",
            " Charge Amount ": " $33.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "841330",
            "Item/Package": "Item",
            "Description": "ASSAY URINE POTASSIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84133",
            " Charge Amount ": " $33.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "841520",
            "Item/Package": "Item",
            "Description": "PROSTATE SPEC ANTIGEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84152",
            " Charge Amount ": " $33.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "856100",
            "Item/Package": "Item",
            "Description": "PROTHROMBIN TIME",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "85610",
            " Charge Amount ": " $33.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "825400",
            "Item/Package": "Item",
            "Description": "ASSAY CREATINE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82540",
            " Charge Amount ": " $34.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "844780",
            "Item/Package": "Item",
            "Description": "TRIGLYCERIDES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84478",
            " Charge Amount ": " $34.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "890550",
            "Item/Package": "Item",
            "Description": "FECAL LEUKO CNT QUAL/SEMIQUAN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "89055",
            " Charge Amount ": " $34.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "824360",
            "Item/Package": "Item",
            "Description": "ASSAY URINE CHLORIDE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82436",
            " Charge Amount ": " $35.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "841320",
            "Item/Package": "Item",
            "Description": "POTASSIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84132",
            " Charge Amount ": " $35.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "843000",
            "Item/Package": "Item",
            "Description": "ASSAY URINE SODIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84300",
            " Charge Amount ": " $35.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "845200",
            "Item/Package": "Item",
            "Description": "BUN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84520",
            " Charge Amount ": " $35.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "845500",
            "Item/Package": "Item",
            "Description": "ASSAY BLOOD URIC ACID",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84550",
            " Charge Amount ": " $35.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "850490",
            "Item/Package": "Item",
            "Description": "BLOOD COUNT PLATELET AUTO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "85049",
            " Charge Amount ": " $35.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "860030",
            "Item/Package": "Item",
            "Description": "ALLER SPC IGE QUAN SEMIQUA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86003",
            " Charge Amount ": " $35.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "864310",
            "Item/Package": "Item",
            "Description": "QUAN RHEUM FACTOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86431",
            " Charge Amount ": " $37.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $25.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "872050",
            "Item/Package": "Item",
            "Description": "SMEAR PRIMARY SOURCE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87205",
            " Charge Amount ": " $37.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $25.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "890510",
            "Item/Package": "Item",
            "Description": "BODY FLUID CELL COUNT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "89051",
            " Charge Amount ": " $37.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $25.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "820430",
            "Item/Package": "Item",
            "Description": "MICROALBUMIN QUANTITATIVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82043",
            " Charge Amount ": " $38.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "841000",
            "Item/Package": "Item",
            "Description": "PHOSPHOR INORGANIC PHOSPHATE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84100",
            " Charge Amount ": " $38.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "842950",
            "Item/Package": "Item",
            "Description": "SODIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84295",
            " Charge Amount ": " $38.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "861400",
            "Item/Package": "Item",
            "Description": "C-REACTIVE PROTEIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86140",
            " Charge Amount ": " $38.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $26.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "820400",
            "Item/Package": "Item",
            "Description": "ASSAY SERUM ALBUMIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82040",
            " Charge Amount ": " $39.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "840750",
            "Item/Package": "Item",
            "Description": "ASSAY ALKALINE PHOSPHATASE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84075",
            " Charge Amount ": " $39.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "844500",
            "Item/Package": "Item",
            "Description": "TRANSFERASE AST SGOT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84450",
            " Charge Amount ": " $39.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "869000",
            "Item/Package": "Item",
            "Description": "BLOOD TYPING ABO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86900",
            " Charge Amount ": " $39.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "869010",
            "Item/Package": "Item",
            "Description": "RH D",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86901",
            " Charge Amount ": " $39.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "823100",
            "Item/Package": "Item",
            "Description": "ASSAY CALCIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82310",
            " Charge Amount ": " $41.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $28.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "825700",
            "Item/Package": "Item",
            "Description": "URINE CREAT CONCENTRATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82570",
            " Charge Amount ": " $41.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $28.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "844600",
            "Item/Package": "Item",
            "Description": "ALANINE AMINO ALT SGPT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84460",
            " Charge Amount ": " $41.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $28.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "870150",
            "Item/Package": "Item",
            "Description": "CONCENTRAT INFECTIOUS AGENTS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87015",
            " Charge Amount ": " $42.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "872060",
            "Item/Package": "Item",
            "Description": "ACID FAST SMEAR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87206",
            " Charge Amount ": " $42.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "837350",
            "Item/Package": "Item",
            "Description": "MAGNESIUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "83735",
            " Charge Amount ": " $43.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $30.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "844790",
            "Item/Package": "Item",
            "Description": "ASSAY TRIIODOTHYRONINE T-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84479",
            " Charge Amount ": " $43.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $30.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "857300",
            "Item/Package": "Item",
            "Description": "PARTIAL THROMBOPLASTIN TIME",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "85730",
            " Charge Amount ": " $45.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $31.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "800760",
            "Item/Package": "Item",
            "Description": "HEPATIC FUNCTION PANEL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "80076",
            " Charge Amount ": " $46.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $32.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "810250",
            "Item/Package": "Item",
            "Description": "URINE PREGNANCY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "81025",
            " Charge Amount ": " $46.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $32.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "825500",
            "Item/Package": "Item",
            "Description": "ASSAY CK CPK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82550",
            " Charge Amount ": " $46.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $32.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "821500",
            "Item/Package": "Item",
            "Description": "AMYLASE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82150",
            " Charge Amount ": " $47.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $32.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "835400",
            "Item/Package": "Item",
            "Description": "IRON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "83540",
            " Charge Amount ": " $47.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $32.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "839350",
            "Item/Package": "Item",
            "Description": "OSMOLALITY URINE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "83935",
            " Charge Amount ": " $47.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $32.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "844360",
            "Item/Package": "Item",
            "Description": "THYROXINE TOTAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84436",
            " Charge Amount ": " $47.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $32.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "850270",
            "Item/Package": "Item",
            "Description": "AUTOMATED HEMOGRAM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "85027",
            " Charge Amount ": " $47.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $32.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "870810",
            "Item/Package": "Item",
            "Description": "PATHOOGY AREBOC SPECIMEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87081",
            " Charge Amount ": " $49.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $34.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "825650",
            "Item/Package": "Item",
            "Description": "CREATININE BLOOD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82565",
            " Charge Amount ": " $51.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $35.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "836900",
            "Item/Package": "Item",
            "Description": "LIPASE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "83690",
            " Charge Amount ": " $51.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $35.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "829770",
            "Item/Package": "Item",
            "Description": "GGT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82977",
            " Charge Amount ": " $53.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $37.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "800470",
            "Item/Package": "Item",
            "Description": "BASIC METABOL PANEL CALC IONIZ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "80047",
            " Charge Amount ": " $55.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $38.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "800480",
            "Item/Package": "Item",
            "Description": "BASIC METABOLIC PANEL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "80048",
            " Charge Amount ": " $55.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $38.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "847030",
            "Item/Package": "Item",
            "Description": "PREGNANCY QUALITATIVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84703",
            " Charge Amount ": " $55.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $38.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "850250",
            "Item/Package": "Item",
            "Description": "CBC WITH DIFF",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "85025",
            " Charge Amount ": " $56.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $39.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "871860",
            "Item/Package": "Item",
            "Description": "ANTIBIOTIC SENSITIVITY MIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87186",
            " Charge Amount ": " $56.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $39.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "890600",
            "Item/Package": "Item",
            "Description": "CRYSTAL IDENTIFICATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "89060",
            " Charge Amount ": " $56.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $39.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "800690",
            "Item/Package": "Item",
            "Description": "RENAL FUNCTION PANEL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "80069",
            " Charge Amount ": " $57.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $39.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "844390",
            "Item/Package": "Item",
            "Description": "ASSAY FREE THYROXINE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84439",
            " Charge Amount ": " $59.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $41.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "853840",
            "Item/Package": "Item",
            "Description": "FIBRINOGEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "85384",
            " Charge Amount ": " $59.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $41.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "870880",
            "Item/Package": "Item",
            "Description": "URINE BACTERIA CULTURE7215",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87088",
            " Charge Amount ": " $59.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $41.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "825530",
            "Item/Package": "Item",
            "Description": "CREATINE MB FRACTION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82553",
            " Charge Amount ": " $62.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "835500",
            "Item/Package": "Item",
            "Description": "IRON BINDING CAPACITY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "83550",
            " Charge Amount ": " $62.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "870770",
            "Item/Package": "Item",
            "Description": "AEROBIC ID",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87077",
            " Charge Amount ": " $62.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "853790",
            "Item/Package": "Item",
            "Description": "FIBRIN DEGRA PRO D-DIMER QUANT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "85379",
            " Charge Amount ": " $63.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $44.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "871020",
            "Item/Package": "Item",
            "Description": "CULTURE FUNGI ISOLATED SOURCE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87102",
            " Charge Amount ": " $63.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $44.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "871770",
            "Item/Package": "Item",
            "Description": "OVA AND PARASITE SMEAR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87177",
            " Charge Amount ": " $63.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $44.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "868500",
            "Item/Package": "Item",
            "Description": "RBC ANTIBODY SCREEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86850",
            " Charge Amount ": " $64.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $44.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "844840",
            "Item/Package": "Item",
            "Description": "TROPONIN QUANTITIVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84484",
            " Charge Amount ": " $66.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "870450",
            "Item/Package": "Item",
            "Description": "STOOL CULTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87045",
            " Charge Amount ": " $66.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "870700",
            "Item/Package": "Item",
            "Description": "CULTURE OTHER SOURCE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87070",
            " Charge Amount ": " $66.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "873400",
            "Item/Package": "Item",
            "Description": "HEPATITIS B SURFACE ANTIGEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87340",
            " Charge Amount ": " $66.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "830360",
            "Item/Package": "Item",
            "Description": "GLYCATED HEMOGLOB TEST HBA1C",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "83036",
            " Charge Amount ": " $67.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "870750",
            "Item/Package": "Item",
            "Description": "AEROBIC ANAEROBIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87075",
            " Charge Amount ": " $69.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $48.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "870400",
            "Item/Package": "Item",
            "Description": "BLOOD CULTURE FOR BACTERIA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87040",
            " Charge Amount ": " $70.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $49.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "800530",
            "Item/Package": "Item",
            "Description": "COMP METABOLIC PANEL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "80053",
            " Charge Amount ": " $73.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $51.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "836050",
            "Item/Package": "Item",
            "Description": "LACTIC ACID ASSAY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "83605",
            " Charge Amount ": " $73.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $51.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "860380",
            "Item/Package": "Item",
            "Description": "ANA-ANTINUCLEAR ANTIBODIES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86038",
            " Charge Amount ": " $73.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $51.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "871160",
            "Item/Package": "Item",
            "Description": "MYCOBACTERIA CULTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87116",
            " Charge Amount ": " $73.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $51.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "867040",
            "Item/Package": "Item",
            "Description": "Hep B Core Anti HBCAB To Total",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86704",
            " Charge Amount ": " $74.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $51.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "867050",
            "Item/Package": "Item",
            "Description": "AB HBCAB IGM AB HEP B",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86705",
            " Charge Amount ": " $74.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $51.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "867060",
            "Item/Package": "Item",
            "Description": "HEPATITIS B SURFACE ANTIBODY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86706",
            " Charge Amount ": " $74.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $51.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "835160",
            "Item/Package": "Item",
            "Description": "IMMUNOASSAY FOR ANALYTE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "83516",
            " Charge Amount ": " $76.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $53.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "861410",
            "Item/Package": "Item",
            "Description": "C-REACTIVE PROT HIGH SENSIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86141",
            " Charge Amount ": " $83.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $58.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "873240",
            "Item/Package": "Item",
            "Description": "CLOSTRIDIUM DIFFICLE TOXIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87324",
            " Charge Amount ": " $84.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $58.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "873290",
            "Item/Package": "Item",
            "Description": "GIARDIA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87329",
            " Charge Amount ": " $84.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $58.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "827460",
            "Item/Package": "Item",
            "Description": "BLOOD FOLIC ACID SERUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82746",
            " Charge Amount ": " $87.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $60.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "800610",
            "Item/Package": "Item",
            "Description": "LIPID PANEL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "80061",
            " Charge Amount ": " $92.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $64.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "823650",
            "Item/Package": "Item",
            "Description": "CALCULUS STONE ASSAY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82365",
            " Charge Amount ": " $93.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $65.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "868030",
            "Item/Package": "Item",
            "Description": "HEPATITIS C ANTIBODY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86803",
            " Charge Amount ": " $95.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $66.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "801620",
            "Item/Package": "Item",
            "Description": "ASSAY FOR DIGOXIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "80162",
            " Charge Amount ": " $96.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $67.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "868000",
            "Item/Package": "Item",
            "Description": "THYROGLOBULIN ANTIBODY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86800",
            " Charge Amount ": " $96.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $67.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "803050",
            "Item/Package": "Item",
            "Description": "DRUG TES PRSMV DIR OPT OBS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "80305",
            " Charge Amount ": " $97.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $67.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "823300",
            "Item/Package": "Item",
            "Description": "ASSAY CALCIUM6569",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82330",
            " Charge Amount ": " $98.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $68.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "827280",
            "Item/Package": "Item",
            "Description": "FERRITIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82728",
            " Charge Amount ": " $98.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $68.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "844320",
            "Item/Package": "Item",
            "Description": "THYROGLOBULIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84432",
            " Charge Amount ": " $98.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $68.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "825330",
            "Item/Package": "Item",
            "Description": "TOTAL CORTISOL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82533",
            " Charge Amount ": " $101.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $70.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "802020",
            "Item/Package": "Item",
            "Description": "ASSAY FOR VANCOMYCIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "80202",
            " Charge Amount ": " $102.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $71.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "826070",
            "Item/Package": "Item",
            "Description": "CYANOCOBALAMIN VIT B-12",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82607",
            " Charge Amount ": " $102.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $71.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "847020",
            "Item/Package": "Item",
            "Description": "GONADOT CHORIONIC HCG QUANT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84702",
            " Charge Amount ": " $102.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $71.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "821050",
            "Item/Package": "Item",
            "Description": "ALPHA-FETOPROTEIN  SERUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82105",
            " Charge Amount ": " $110.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $77.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100018",
            "Item/Package": "Item",
            "Description": "PROSTATE CANCER SCREEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "G0103",
            " Charge Amount ": " $112.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $78.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "830010",
            "Item/Package": "Item",
            "Description": "GONADOTROPIN FSH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "83001",
            " Charge Amount ": " $112.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $78.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "830020",
            "Item/Package": "Item",
            "Description": "GONADOTROPIN LH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "83002",
            " Charge Amount ": " $112.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $78.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "844430",
            "Item/Package": "Item",
            "Description": "TSH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84443",
            " Charge Amount ": " $115.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $80.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "863760",
            "Item/Package": "Item",
            "Description": "MICROSOMAL ANTIBODY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86376",
            " Charge Amount ": " $116.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $81.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "872090",
            "Item/Package": "Item",
            "Description": "COMPLES SPECIAL STAIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87209",
            " Charge Amount ": " $118.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $82.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "826720",
            "Item/Package": "Item",
            "Description": "ESTROGEN ASSAY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82672",
            " Charge Amount ": " $126.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $88.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "823780",
            "Item/Package": "Item",
            "Description": "CEA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82378",
            " Charge Amount ": " $129.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $90.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "841530",
            "Item/Package": "Item",
            "Description": "PSA TOTAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84153",
            " Charge Amount ": " $129.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $90.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "844800",
            "Item/Package": "Item",
            "Description": "TOTAL ASSAY, TT-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84480",
            " Charge Amount ": " $129.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $90.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "828030",
            "Item/Package": "Item",
            "Description": "GASES BLOOD ANY COMBINATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82803",
            " Charge Amount ": " $133.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $93.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "844810",
            "Item/Package": "Item",
            "Description": "FREE ASSAY FT-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84481",
            " Charge Amount ": " $135.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $94.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "826700",
            "Item/Package": "Item",
            "Description": "ESTRADOL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82670",
            " Charge Amount ": " $145.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $101.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "842440",
            "Item/Package": "Item",
            "Description": "Assay of Renin",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84244",
            " Charge Amount ": " $145.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $101.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "844020",
            "Item/Package": "Item",
            "Description": "TESTOSTERONE FREE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84402",
            " Charge Amount ": " $151.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $105.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "844030",
            "Item/Package": "Item",
            "Description": "ASSAY TOTAL TESTOSTERONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84403",
            " Charge Amount ": " $153.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $107.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "C98030",
            "Item/Package": "Item",
            "Description": "HOPD COVID-19 SPEC COLLECT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "C9803",
            " Charge Amount ": " $159.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $111.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "841440",
            "Item/Package": "Item",
            "Description": "ASSAY PROGESTERONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84144",
            " Charge Amount ": " $162.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $113.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "868700",
            "Item/Package": "Item",
            "Description": "RBC ANTIBODY IDENTIFICATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86870",
            " Charge Amount ": " $163.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $114.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881420",
            "Item/Package": "Item",
            "Description": "CP CERV/VAG ATL  MANUAL SCRN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "88142",
            " Charge Amount ": " $164.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $114.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "823060",
            "Item/Package": "Item",
            "Description": "ASSAY OF VITAMIN D",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82306",
            " Charge Amount ": " $212.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $148.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "812910",
            "Item/Package": "Item",
            "Description": "MTHFR GENE ANALY COMM VARIANTS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "81291",
            " Charge Amount ": " $241.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $168.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "839700",
            "Item/Package": "Item",
            "Description": "ASSAY OF PARATHORMONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "83970",
            " Charge Amount ": " $264.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $184.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "844450",
            "Item/Package": "Item",
            "Description": "THYROID IMMUNOGLOBULINS TSI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84445",
            " Charge Amount ": " $279.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $195.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "G04800",
            "Item/Package": "Item",
            "Description": "DRUG TEST DEF 1-7 CLASSES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "G0480",
            " Charge Amount ": " $286.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $200.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "834980",
            "Item/Package": "Item",
            "Description": "HYDROXYPROGESTERONE 17 D",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "83498",
            " Charge Amount ": " $312.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $218.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "812410",
            "Item/Package": "Item",
            "Description": "F5 COAG FACTOR V ANAL LEID VAR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "81241",
            " Charge Amount ": " $323.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $226.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "869050",
            "Item/Package": "Item",
            "Description": "BLOOD TYPING RBC ANTIGENS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "86905",
            " Charge Amount ": " $331.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $231.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "803070",
            "Item/Package": "Item",
            "Description": "DRUG TEST PRSMV CHEM ANLYZR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "80307",
            " Charge Amount ": " $397.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $277.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "841450",
            "Item/Package": "Item",
            "Description": "PROCALCITONIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84145",
            " Charge Amount ": " $398.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $278.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "803490",
            "Item/Package": "Item",
            "Description": "CANNABINOIDS NATURAL DRUG SCR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "80349",
            " Charge Amount ": " $444.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $310.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "U00030",
            "Item/Package": "Item",
            "Description": "COV-19 AMP PRB HGH THRUPUT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "U0003",
            " Charge Amount ": " $795.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $556.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "803530",
            "Item/Package": "Item",
            "Description": "DRUG SCREENING COCAINE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "301",
            "CPT/HCPCS/DRG": "80353",
            " Charge Amount ": " $350.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $244.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "876350",
            "Item/Package": "Item",
            "Description": "SARS-COV-2 COVID-19 AMP PRB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "306",
            "CPT/HCPCS/DRG": "87635",
            " Charge Amount ": " $371.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $259.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883110",
            "Item/Package": "Item",
            "Description": "DECALCIFY TISSUE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88311",
            " Charge Amount ": " $67.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883290",
            "Item/Package": "Item",
            "Description": "PATHOLOGY CONS IN SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88329",
            " Charge Amount ": " $67.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883020",
            "Item/Package": "Item",
            "Description": "SURG PATH LVL 2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88302",
            " Charge Amount ": " $67.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883000",
            "Item/Package": "Item",
            "Description": "SURG PATH LEVEL-I GROSS ONLY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88300",
            " Charge Amount ": " $68.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $47.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883120",
            "Item/Package": "Item",
            "Description": "SPECIAL STAINS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88312",
            " Charge Amount ": " $70.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $49.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883130",
            "Item/Package": "Item",
            "Description": "SPECIAL STAINS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88313",
            " Charge Amount ": " $70.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $49.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883320",
            "Item/Package": "Item",
            "Description": "PATHOLOGY CONS IN SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88332",
            " Charge Amount ": " $73.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $51.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881840",
            "Item/Package": "Item",
            "Description": "FLOW CYTOMETRY TC 1ST MARKER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88184",
            " Charge Amount ": " $75.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $52.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881850",
            "Item/Package": "Item",
            "Description": "FLOW CYTOMETRY EA ADDL MARKER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88185",
            " Charge Amount ": " $75.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $52.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881770",
            "Item/Package": "Item",
            "Description": "CYTP FNA EVAL EA ADDL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88177",
            " Charge Amount ": " $88.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $61.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881720",
            "Item/Package": "Item",
            "Description": "CYTP DX EVAL FNA 1ST EA SITE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88172",
            " Charge Amount ": " $127.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $88.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883500",
            "Item/Package": "Item",
            "Description": "IMMUNOFLUOR ANTB ADDL STAIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88350",
            " Charge Amount ": " $139.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $97.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883040",
            "Item/Package": "Item",
            "Description": "TISSUE EX BY PATHOLOGIST LVL 3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88304",
            " Charge Amount ": " $146.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $102.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883310",
            "Item/Package": "Item",
            "Description": "PATHOLOGY CONSULT IN SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88331",
            " Charge Amount ": " $146.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $102.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883330",
            "Item/Package": "Item",
            "Description": "INTRAOP CYTO PATH CONSULT 1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88333",
            " Charge Amount ": " $148.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $103.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883410",
            "Item/Package": "Item",
            "Description": "Each Add'l Antibody Stain Proc",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88341",
            " Charge Amount ": " $151.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $105.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881120",
            "Item/Package": "Item",
            "Description": "CYTOPATH CELL ENHANCE TECH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88112",
            " Charge Amount ": " $152.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $106.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883050",
            "Item/Package": "Item",
            "Description": "TISSUE EX BY PATHOLOGIST LVL 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88305",
            " Charge Amount ": " $152.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $106.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883420",
            "Item/Package": "Item",
            "Description": "IMMUNOCYTOCHEMISTRY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88342",
            " Charge Amount ": " $152.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $106.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883600",
            "Item/Package": "Item",
            "Description": "TUMOR IMMUNOHISTOC/MANUAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88360",
            " Charge Amount ": " $152.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $106.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881880",
            "Item/Package": "Item",
            "Description": "9 TO 15 MARKERS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88188",
            " Charge Amount ": " $162.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $113.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881890",
            "Item/Package": "Item",
            "Description": "FLW CYTOMET INTERP 16 & > MARK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88189",
            " Charge Amount ": " $162.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $113.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883090",
            "Item/Package": "Item",
            "Description": "TISSUE EX BY PATHOLOGIST LVL 6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88309",
            " Charge Amount ": " $226.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $158.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881730",
            "Item/Package": "Item",
            "Description": "INTERPRETATION OF SMEAR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88173",
            " Charge Amount ": " $231.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $161.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883070",
            "Item/Package": "Item",
            "Description": "TISSUE EX BY PATHOLOGIST LVL 5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88307",
            " Charge Amount ": " $237.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $165.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "875910",
            "Item/Package": "Item",
            "Description": "NEISSERIA AMPLIF NA PROBE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "87591",
            " Charge Amount ": " $240.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $168.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "838800",
            "Item/Package": "Item",
            "Description": "B-TYPE NATRIURETIC PEPTIDE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "83880",
            " Charge Amount ": " $269.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $188.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883740",
            "Item/Package": "Item",
            "Description": "M/PHMTRC ALYS ISHQUANT/SEMIQ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88374",
            " Charge Amount ": " $782.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $547.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "882620",
            "Item/Package": "Item",
            "Description": "CHROMOSOME COUNT 15-20 CELLS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88262",
            " Charge Amount ": " $811.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $567.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "882330",
            "Item/Package": "Item",
            "Description": "TISSUE CULTURE SKIN/BIOPSY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88233",
            " Charge Amount ": " $946.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $662.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100081",
            "Item/Package": "Item",
            "Description": "KYPHOPLASTY STATISTICAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100092",
            "Item/Package": "Item",
            "Description": "DICTATION FOR CESI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100093",
            "Item/Package": "Item",
            "Description": "DICTATION FOR LESI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736603",
            "Item/Package": "Item",
            "Description": "XR TOES RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73660",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730903",
            "Item/Package": "Item",
            "Description": "XR FOREARM RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770030",
            "Item/Package": "Item",
            "Description": "FL SPINE INJECT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "77003",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730902",
            "Item/Package": "Item",
            "Description": "XR FOREARM LT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731100",
            "Item/Package": "Item",
            "Description": "XR WRIST BL COMPLETE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73110",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731300",
            "Item/Package": "Item",
            "Description": "XR HAND BL 3V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73130",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730203",
            "Item/Package": "Item",
            "Description": "XR SHOULDER RT 1V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770020",
            "Item/Package": "Item",
            "Description": "FL GUIDED INJECTION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "77002",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720400",
            "Item/Package": "Item",
            "Description": "XR SPINE CERVICAL 3 V/L",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72040",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "743000",
            "Item/Package": "Item",
            "Description": "CHOLANGIOGRAM INTRAOP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74300",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720700",
            "Item/Package": "Item",
            "Description": "XR THORACIC SPINE 2 V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72070",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735902",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA LT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720200",
            "Item/Package": "Item",
            "Description": "XR LUMBAR SPINE 1V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735603",
            "Item/Package": "Item",
            "Description": "XR KNEE RT LIMITED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770010",
            "Item/Package": "Item",
            "Description": "FL GUIDE CENTRAL VEN ACC DEV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "77001",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736302",
            "Item/Package": "Item",
            "Description": "XR FOOT LT 3V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735604",
            "Item/Package": "Item",
            "Description": "XR KNEE BL LIMITED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730202",
            "Item/Package": "Item",
            "Description": "XR SHOULDER LT 1V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735012",
            "Item/Package": "Item",
            "Description": "XR HIP UNI 1V LT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73501",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735602",
            "Item/Package": "Item",
            "Description": "XR KNEE LT LIMITED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720810",
            "Item/Package": "Item",
            "Description": "XR ENTIRE SPINE 1V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72081",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730300",
            "Item/Package": "Item",
            "Description": "XR SHOULDER COMPLETE BL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73030",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736103",
            "Item/Package": "Item",
            "Description": "XR ANKLE RT COMPLETE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73610",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730603",
            "Item/Package": "Item",
            "Description": "XR HUMERUS RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736303",
            "Item/Package": "Item",
            "Description": "XR FOOT RT 3V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720500",
            "Item/Package": "Item",
            "Description": "XR SPINE CERVICAL 4 OR 5 VIEWS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72050",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720520",
            "Item/Package": "Item",
            "Description": "XR SPINE CERVICAL W FLEX EXTEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72052",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735010",
            "Item/Package": "Item",
            "Description": "XR HIP UNI 1V RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73501",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735022",
            "Item/Package": "Item",
            "Description": "XR HIP UNI/PELVIS 2-3V RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73502",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735023",
            "Item/Package": "Item",
            "Description": "XR HIP UNI/PELVIS 2-3V LT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73502",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731303",
            "Item/Package": "Item",
            "Description": "XR HAND RT 3V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73130",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730303",
            "Item/Package": "Item",
            "Description": "XR SHOULDER RT COMPLETE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73030",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735650",
            "Item/Package": "Item",
            "Description": "XR KNEE STANDING AP BL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73565",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721700",
            "Item/Package": "Item",
            "Description": "XR PELVIS AP VIEW",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72170",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731204",
            "Item/Package": "Item",
            "Description": "XR HANS BL 2V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731102",
            "Item/Package": "Item",
            "Description": "XR WRIST LT COMPLETE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73110",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735210",
            "Item/Package": "Item",
            "Description": "XR Hips BL W/PELVIS 2V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73521",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730302",
            "Item/Package": "Item",
            "Description": "XR SHOULDER LT COMPLETE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73030",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730602",
            "Item/Package": "Item",
            "Description": "XR HUMERUS LT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736002",
            "Item/Package": "Item",
            "Description": "XR ANKLE LT LIMITED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735903",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736102",
            "Item/Package": "Item",
            "Description": "XR ANKLE LT COMPLETE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73610",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731302",
            "Item/Package": "Item",
            "Description": "XR HAND LT 3V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73130",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731202",
            "Item/Package": "Item",
            "Description": "XR HAND LT 2V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731403",
            "Item/Package": "Item",
            "Description": "XR FINGER RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73140",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730803",
            "Item/Package": "Item",
            "Description": "XR ELBOW RT COMPLETE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736304",
            "Item/Package": "Item",
            "Description": "XR FOOT BL 3V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731103",
            "Item/Package": "Item",
            "Description": "XR WRIST RT COMPLETE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73110",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731203",
            "Item/Package": "Item",
            "Description": "XR HAND RT 2V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736003",
            "Item/Package": "Item",
            "Description": "XR ANKLE RT LIMITED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730702",
            "Item/Package": "Item",
            "Description": "XR ELBOW LT LIMITED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73070",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730802",
            "Item/Package": "Item",
            "Description": "XR ELBOW LT COMPLETE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730804",
            "Item/Package": "Item",
            "Description": "XR ELBOW BI COMPLETE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731402",
            "Item/Package": "Item",
            "Description": "XR FINGER LT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73140",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735600",
            "Item/Package": "Item",
            "Description": "XR KNEE LIMITED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736004",
            "Item/Package": "Item",
            "Description": "XR ANKLE BL LIMITED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736100",
            "Item/Package": "Item",
            "Description": "XR ANKLE BL COMPLETE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73610",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "760000",
            "Item/Package": "Item",
            "Description": "FL FLUOROSCOPY <1hr",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "76000",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $201.67 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770023",
            "Item/Package": "Item",
            "Description": "FL GUIDED ASPIRATION JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "77002",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740220",
            "Item/Package": "Item",
            "Description": "XR SERIES ABDOMEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74022",
            " Charge Amount ": " $572.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $400.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721200",
            "Item/Package": "Item",
            "Description": "XR LOWER SPINE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72120",
            " Charge Amount ": " $572.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $400.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702000",
            "Item/Package": "Item",
            "Description": "XR ORBIT COMPLETE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70200",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702200",
            "Item/Package": "Item",
            "Description": "XR SINUSES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70220",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702600",
            "Item/Package": "Item",
            "Description": "XR SKULL COMPLETE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70260",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721900",
            "Item/Package": "Item",
            "Description": "XR PELVIS MIN 3 V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72190",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730002",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE LT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730103",
            "Item/Package": "Item",
            "Description": "XR SCAPULA RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730703",
            "Item/Package": "Item",
            "Description": "XR ELBOW RT LIMITED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73070",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731003",
            "Item/Package": "Item",
            "Description": "XR WRIST RT LIMITED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736203",
            "Item/Package": "Item",
            "Description": "XR FOOT RT 2V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736503",
            "Item/Package": "Item",
            "Description": "XR CALCANEUS RT 2V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "722020",
            "Item/Package": "Item",
            "Description": "XR SACROILIAC JOINTS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72202",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "722200",
            "Item/Package": "Item",
            "Description": "XR SACRUM COCYX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72220",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735643",
            "Item/Package": "Item",
            "Description": "XR KNEE RT 4V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73564",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735522",
            "Item/Package": "Item",
            "Description": "XR FEMUR 2/> RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73552",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770730",
            "Item/Package": "Item",
            "Description": "XR BONE LENGTH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "77073",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731002",
            "Item/Package": "Item",
            "Description": "XR WRIST LT LIMITED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736202",
            "Item/Package": "Item",
            "Description": "XR FOOT LT 2V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721140",
            "Item/Package": "Item",
            "Description": "XR LUMBAR SPINE 6V W BENDING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72114",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735624",
            "Item/Package": "Item",
            "Description": "XR KNEE BL 3V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735642",
            "Item/Package": "Item",
            "Description": "XR KNEE LT 4V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73564",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "760980",
            "Item/Package": "Item",
            "Description": "XR BREAST SPECIMEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "76098",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $201.67 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735623",
            "Item/Package": "Item",
            "Description": "XR KNEE RT 3V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735640",
            "Item/Package": "Item",
            "Description": "XR KNEE BL 4V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73564",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721000",
            "Item/Package": "Item",
            "Description": "XR LUMBAR SPINE  2-3V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740180",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN 1V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74018",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735523",
            "Item/Package": "Item",
            "Description": "XR FEMUR 2/>LT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73552",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735622",
            "Item/Package": "Item",
            "Description": "XR KNEE LT 3V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "722000",
            "Item/Package": "Item",
            "Description": "XR SACROILIAC JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72200",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740190",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN 2V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74019",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720720",
            "Item/Package": "Item",
            "Description": "XR THORACIC SPINE 3V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72072",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721100",
            "Item/Package": "Item",
            "Description": "XR LOWER SPINE MIN 4V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72110",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736204",
            "Item/Package": "Item",
            "Description": "XR FOOT BL 2V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730003",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731004",
            "Item/Package": "Item",
            "Description": "XR WRIST BL LIMITED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "744200",
            "Item/Package": "Item",
            "Description": "RETROGRADE PYELOGRAM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74420",
            " Charge Amount ": " $765.00 ",
            " Min Reimb ": " $201.67 ",
            " Max Reimb ": " $535.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "744300",
            "Item/Package": "Item",
            "Description": "CYSTOGRAPHY 3V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74430",
            " Charge Amount ": " $766.00 ",
            " Min Reimb ": " $201.67 ",
            " Max Reimb ": " $536.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "747400",
            "Item/Package": "Item",
            "Description": "FL HYSTEROSALPINGOGRAPHY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74740",
            " Charge Amount ": " $783.00 ",
            " Min Reimb ": " $201.67 ",
            " Max Reimb ": " $548.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "744250",
            "Item/Package": "Item",
            "Description": "FL CYSTOGRAM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74425",
            " Charge Amount ": " $854.00 ",
            " Min Reimb ": " $201.67 ",
            " Max Reimb ": " $597.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100300",
            "Item/Package": "Item",
            "Description": "GUIDE CATHET FLUID DRAINAGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "10030",
            " Charge Amount ": " $2,935.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,054.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711010",
            "Item/Package": "Item",
            "Description": "XR RIBS CHEST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71101",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711114",
            "Item/Package": "Item",
            "Description": "XR RIBS BI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71111",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711200",
            "Item/Package": "Item",
            "Description": "XR STERNUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71120",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "I000000010",
            "Item/Package": "Item",
            "Description": "XR RIBS LT W CHEST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71101",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "I000000011",
            "Item/Package": "Item",
            "Description": "XR RIBS RT W CHEST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71101",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710450",
            "Item/Package": "Item",
            "Description": "XR CHEST 1V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71045",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710460",
            "Item/Package": "Item",
            "Description": "XR CHEST 2V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71046",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710480",
            "Item/Package": "Item",
            "Description": "XR CHEST 4+V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71048",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711300",
            "Item/Package": "Item",
            "Description": "XR BREASTBONE 3V",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71130",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $72.48 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90760",
            "Item/Package": "Item",
            "Description": "TC99M SULFUR COLLOID =< 20 MCI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "343",
            "CPT/HCPCS/DRG": "A9541",
            " Charge Amount ": " $233.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $163.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770120",
            "Item/Package": "Item",
            "Description": "CT BIOPSY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "77012",
            " Charge Amount ": " $339.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $237.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741760",
            "Item/Package": "Item",
            "Description": "CT ABDOMEN/PELVIS WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "74176",
            " Charge Amount ": " $1,190.00 ",
            " Min Reimb ": " $206.17 ",
            " Max Reimb ": " $833.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741780",
            "Item/Package": "Item",
            "Description": "CT ABDOMEN/PELVIS W/ WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "74178",
            " Charge Amount ": " $1,327.00 ",
            " Min Reimb ": " $329.80 ",
            " Max Reimb ": " $928.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "763760",
            "Item/Package": "Item",
            "Description": "CT 3D RECONSTRUCTION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "76376",
            " Charge Amount ": " $1,337.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $935.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721250",
            "Item/Package": "Item",
            "Description": "CT CERVICAL SPINE WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "72125",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721280",
            "Item/Package": "Item",
            "Description": "CT THORACIC SPINE WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "72128",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721310",
            "Item/Package": "Item",
            "Description": "CT LUMBAR SPINE WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "72131",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741500",
            "Item/Package": "Item",
            "Description": "CT ABDOOMENT WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "74150",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721320",
            "Item/Package": "Item",
            "Description": "CT LUMBAR SPINE W CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "72132",
            " Charge Amount ": " $1,902.00 ",
            " Min Reimb ": " $329.80 ",
            " Max Reimb ": " $1,331.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "202250",
            "Item/Package": "Item",
            "Description": "CT DEEP BONE BIOPSY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "20225",
            " Charge Amount ": " $4,219.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,953.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704500",
            "Item/Package": "Item",
            "Description": "CT HEAD/BRAIN WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70450",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704700",
            "Item/Package": "Item",
            "Description": "CT HEAD/BRAIN WO/W CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70470",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $159.96 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704800",
            "Item/Package": "Item",
            "Description": "CT ORBITSEL MID/IN EAR W/O CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70480",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704860",
            "Item/Package": "Item",
            "Description": "CT FACIAL BONES WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70486",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704870",
            "Item/Package": "Item",
            "Description": "CT SINUS W CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70487",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $159.96 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704900",
            "Item/Package": "Item",
            "Description": "CT SOFT TISSUE NECK WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70490",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704910",
            "Item/Package": "Item",
            "Description": "CT SOFT TISSUE NECK W CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70491",
            " Charge Amount ": " $1,943.00 ",
            " Min Reimb ": " $159.96 ",
            " Max Reimb ": " $1,360.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704880",
            "Item/Package": "Item",
            "Description": "CT SINUS WO/W CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70488",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $159.96 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741770",
            "Item/Package": "Item",
            "Description": "CT ABDOMEN/PELVIS W CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "74177",
            " Charge Amount ": " $1,190.00 ",
            " Min Reimb ": " $329.80 ",
            " Max Reimb ": " $833.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "712500",
            "Item/Package": "Item",
            "Description": "CT CHEST WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "71250",
            " Charge Amount ": " $1,586.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $1,110.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721920",
            "Item/Package": "Item",
            "Description": "CT PELVIS WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "72192",
            " Charge Amount ": " $1,586.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $1,110.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721930",
            "Item/Package": "Item",
            "Description": "CT PELVIS W CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "72193",
            " Charge Amount ": " $1,943.00 ",
            " Min Reimb ": " $159.96 ",
            " Max Reimb ": " $1,360.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741600",
            "Item/Package": "Item",
            "Description": "CT ABDOMEN W CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "74160",
            " Charge Amount ": " $1,943.00 ",
            " Min Reimb ": " $159.96 ",
            " Max Reimb ": " $1,360.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "712600",
            "Item/Package": "Item",
            "Description": "CT CHEST W CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "71260",
            " Charge Amount ": " $1,945.00 ",
            " Min Reimb ": " $159.96 ",
            " Max Reimb ": " $1,361.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741700",
            "Item/Package": "Item",
            "Description": "CT ABDOMEN WO/W CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "74170",
            " Charge Amount ": " $2,432.00 ",
            " Min Reimb ": " $159.96 ",
            " Max Reimb ": " $1,702.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "712750",
            "Item/Package": "Item",
            "Description": "CTA CHEST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "71275",
            " Charge Amount ": " $2,603.00 ",
            " Min Reimb ": " $159.96 ",
            " Max Reimb ": " $1,822.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "325550",
            "Item/Package": "Item",
            "Description": "CT GUIDED THORACENTESIS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "32555",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "502002",
            "Item/Package": "Item",
            "Description": "CT BIOPSY RENAL LT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "50200",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "502003",
            "Item/Package": "Item",
            "Description": "CT BIOPSY RENAL RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "50200",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704826",
            "Item/Package": "Item",
            "Description": "CT INTERNAL AUDIOTRY CANALS BI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "70482",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $159.96 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732003",
            "Item/Package": "Item",
            "Description": "CT ELBOW RT WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73200",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737002",
            "Item/Package": "Item",
            "Description": "CT ANKLE LT WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73700",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737003",
            "Item/Package": "Item",
            "Description": "CT ANKLE RT W CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73700",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7320015",
            "Item/Package": "Item",
            "Description": "CT SHOULDER RT WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73200",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7370011",
            "Item/Package": "Item",
            "Description": "CT HIP RT WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73700",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7370012",
            "Item/Package": "Item",
            "Description": "CT KNEE LT WO CON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73700",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100069",
            "Item/Package": "Item",
            "Description": "ROBOTIC SYSTEM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "S2900",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "SURCHGFWD",
            "Item/Package": "Item",
            "Description": "SUR CHG FWD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100007",
            "Item/Package": "Item",
            "Description": "OR LEVEL I 15 MIN INCREMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $501.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $350.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100009",
            "Item/Package": "Item",
            "Description": "OR LEVEL II 15 MIN INCREMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $667.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $466.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100011",
            "Item/Package": "Item",
            "Description": "OR LEVEL III 15 MIN INCREMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,002.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $701.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100013",
            "Item/Package": "Item",
            "Description": "OR LEVEL IV 15 MIN INCREMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,167.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $816.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100015",
            "Item/Package": "Item",
            "Description": "OR LEVEL V 15 MIN INCREMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,335.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $934.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100070",
            "Item/Package": "Item",
            "Description": "Additional Procedure",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,667.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,166.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100072",
            "Item/Package": "Item",
            "Description": "Additional Procedure 3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,667.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,166.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100073",
            "Item/Package": "Item",
            "Description": "Additional Procedure 4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,667.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,166.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100074",
            "Item/Package": "Item",
            "Description": "Additional Procedure 5",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,667.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,166.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100075",
            "Item/Package": "Item",
            "Description": "ADDITIONAL PROCEDURE 6",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,667.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,166.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100076",
            "Item/Package": "Item",
            "Description": "ADDITIONAL PROCEDURE 7",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,667.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,166.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100077",
            "Item/Package": "Item",
            "Description": "ADDITIONAL PROCEDURE 8",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,667.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,166.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100078",
            "Item/Package": "Item",
            "Description": "ADDITIONAL PROCEDURE 9",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,667.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,166.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100083",
            "Item/Package": "Item",
            "Description": "ADDITIONAL PROCEDURE 10",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,667.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,166.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100084",
            "Item/Package": "Item",
            "Description": "ADDITIONAL PROCEDURE 11",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,667.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,166.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100085",
            "Item/Package": "Item",
            "Description": "ADDITIONAL PROCEDURE 12",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,667.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,166.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100086",
            "Item/Package": "Item",
            "Description": "ADDITIONAL PROCEDURE 13",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,667.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,166.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100087",
            "Item/Package": "Item",
            "Description": "ADDITIONAL PROCEDURE 14",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,667.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,166.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100006",
            "Item/Package": "Item",
            "Description": "OR LEVEL I INITIAL 30 MINS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,616.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,831.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100008",
            "Item/Package": "Item",
            "Description": "OR LEVEL II INITIAL 30 MINS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3,450.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,415.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100010",
            "Item/Package": "Item",
            "Description": "OR LEVEL III INITIAL 30 MINS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5,119.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3,583.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100017",
            "Item/Package": "Item",
            "Description": "OR LEVEL VI 15 MIN INCREMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5,353.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3,747.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100012",
            "Item/Package": "Item",
            "Description": "OR LEVEL IV INITIAL 30 MINS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5,953.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4,167.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100014",
            "Item/Package": "Item",
            "Description": "OR LEVEL V INITIAL 30 MINS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6,786.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4,750.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100016",
            "Item/Package": "Item",
            "Description": "OR LEVEL VI INITIAL 30 MINS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $11,964.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8,374.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100037",
            "Item/Package": "Item",
            "Description": "LEUKOCYTE RED BLOOD EA UNIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "381",
            "CPT/HCPCS/DRG": "P9016",
            " Charge Amount ": " $835.00 ",
            " Min Reimb ": " $168.89 ",
            " Max Reimb ": " $584.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100038",
            "Item/Package": "Item",
            "Description": "LEUKOCYTE RED BLOOD EA UNIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "381",
            "CPT/HCPCS/DRG": "P9016",
            " Charge Amount ": " $835.00 ",
            " Min Reimb ": " $168.89 ",
            " Max Reimb ": " $584.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100039",
            "Item/Package": "Item",
            "Description": "RED BLOOD CELLS EA UNIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "381",
            "CPT/HCPCS/DRG": "P9010",
            " Charge Amount ": " $835.00 ",
            " Min Reimb ": " $134.51 ",
            " Max Reimb ": " $584.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "P9040",
            "Item/Package": "Item",
            "Description": "RED BLOOD CELLS IRRAD LEUK RED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "381",
            "CPT/HCPCS/DRG": "P9040",
            " Charge Amount ": " $941.00 ",
            " Min Reimb ": " $233.43 ",
            " Max Reimb ": " $658.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "P9058",
            "Item/Package": "Item",
            "Description": "CMV-NEG LR IRRAD RCB EA UNIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "381",
            "CPT/HCPCS/DRG": "P9058",
            " Charge Amount ": " $2,300.00 ",
            " Min Reimb ": " $218.48 ",
            " Max Reimb ": " $1,610.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "364300",
            "Item/Package": "Item",
            "Description": "BLOOD TRANSFUSION SERVICE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "391",
            "CPT/HCPCS/DRG": "36430",
            " Charge Amount ": " $930.00 ",
            " Min Reimb ": " $355.73 ",
            " Max Reimb ": " $651.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "769370",
            "Item/Package": "Item",
            "Description": "US GUIDE VASCULAR ACCESS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76937",
            " Charge Amount ": " $121.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $84.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "768820",
            "Item/Package": "Item",
            "Description": "US EXTREM NONVAS W IM DOC LTD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76882",
            " Charge Amount ": " $242.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $169.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "768810",
            "Item/Package": "Item",
            "Description": "US EXTREMITY NONVASCULAR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76881",
            " Charge Amount ": " $369.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $258.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "769420",
            "Item/Package": "Item",
            "Description": "US GUIDED NEEDLE PLACEMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76942",
            " Charge Amount ": " $400.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $280.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "767750",
            "Item/Package": "Item",
            "Description": "US RETROPERITONEAL LIMITED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76775",
            " Charge Amount ": " $401.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $280.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "768560",
            "Item/Package": "Item",
            "Description": "US PELVIC COMPLETE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76856",
            " Charge Amount ": " $401.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $280.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "769980",
            "Item/Package": "Item",
            "Description": "US GUIDE INTRAOP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76998",
            " Charge Amount ": " $401.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $280.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "768720",
            "Item/Package": "Item",
            "Description": "US TRANSRECTAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76872",
            " Charge Amount ": " $1,076.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $753.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "946600",
            "Item/Package": "Item",
            "Description": "POS AIRWAY PRESSURE CPAP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "410",
            "CPT/HCPCS/DRG": "94660",
            " Charge Amount ": " $393.00 ",
            " Min Reimb ": " $168.32 ",
            " Max Reimb ": " $275.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "940020",
            "Item/Package": "Item",
            "Description": "VENT MGMT INPT/OBV INIT DAY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "410",
            "CPT/HCPCS/DRG": "94002",
            " Charge Amount ": " $820.00 ",
            " Min Reimb ": " $322.32 ",
            " Max Reimb ": " $574.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "971400",
            "Item/Package": "Item",
            "Description": "MANUAL THERAPY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "420",
            "CPT/HCPCS/DRG": "97140",
            " Charge Amount ": " $67.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "971160",
            "Item/Package": "Item",
            "Description": "GAIT TRAINING THERAPY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "420",
            "CPT/HCPCS/DRG": "97116",
            " Charge Amount ": " $76.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $53.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "975300",
            "Item/Package": "Item",
            "Description": "THERAPEUTIC ACTIVITIES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "420",
            "CPT/HCPCS/DRG": "97530",
            " Charge Amount ": " $86.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $60.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "975350",
            "Item/Package": "Item",
            "Description": "SELF CARE MANAGEMENET TRAINING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "420",
            "CPT/HCPCS/DRG": "97535",
            " Charge Amount ": " $121.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $84.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "977600",
            "Item/Package": "Item",
            "Description": "ORTHOTIC MGMT/TRAIN EA 15 MINS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "420",
            "CPT/HCPCS/DRG": "97760",
            " Charge Amount ": " $121.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $84.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "971100",
            "Item/Package": "Item",
            "Description": "THERAPEUTIC EXERCISES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "420",
            "CPT/HCPCS/DRG": "97110",
            " Charge Amount ": " $136.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $95.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "970040",
            "Item/Package": "Item",
            "Description": "OCCUPATIONAL THERAPY RE-EVAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "434",
            "CPT/HCPCS/DRG": "97004",
            " Charge Amount ": " $187.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $130.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "971650",
            "Item/Package": "Item",
            "Description": "OT EVAL LOW COMPLEX 30 MIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "434",
            "CPT/HCPCS/DRG": "97165",
            " Charge Amount ": " $339.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $237.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90907",
            "Item/Package": "Item",
            "Description": "DEXAMETHASONE 4MG/ML 5ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1100",
            " Charge Amount ": " $0.52 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $0.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000016",
            "Item/Package": "Item",
            "Description": "DEXAMETHASONE 1MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1100",
            " Charge Amount ": " $1.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000012",
            "Item/Package": "Item",
            "Description": "FENTANYL CITRATE INJ/.01 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3010",
            " Charge Amount ": " $2.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90540",
            "Item/Package": "Item",
            "Description": "ONDANSETRON 4 MG/2 ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2405",
            " Charge Amount ": " $2.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90183",
            "Item/Package": "Item",
            "Description": "DEXAMETHASONE 4 MG/ML VL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1100",
            " Charge Amount ": " $3.17 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90774",
            "Item/Package": "Item",
            "Description": "HOCM <=149 MG/ML IODINE. 1ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "Q9958",
            " Charge Amount ": " $3.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90776",
            "Item/Package": "Item",
            "Description": "LOCM 300-399MG/ML IODINE 1ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "Q9967",
            " Charge Amount ": " $4.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90775",
            "Item/Package": "Item",
            "Description": "LOCM 200-299MG/ML IODINE 1ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "Q9966",
            " Charge Amount ": " $4.32 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90944",
            "Item/Package": "Item",
            "Description": "TORADOL 15 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1885",
            " Charge Amount ": " $4.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90129",
            "Item/Package": "Item",
            "Description": "CEFAZOLIN (ANCEF) 500 MG VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0690",
            " Charge Amount ": " $4.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90181",
            "Item/Package": "Item",
            "Description": "DEXAMETHASONE 10 MG/ML VL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1100",
            " Charge Amount ": " $4.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90259",
            "Item/Package": "Item",
            "Description": "FENTANYL 100 MCG/2 ML AMPUL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3010",
            " Charge Amount ": " $5.22 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90425",
            "Item/Package": "Item",
            "Description": "LIDOCAINE 1% 20 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2001",
            " Charge Amount ": " $5.46 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91014",
            "Item/Package": "Item",
            "Description": "DEXAMETHASONE PF 4MG/ML SYRING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1100",
            " Charge Amount ": " $7.09 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90885",
            "Item/Package": "Item",
            "Description": "FUROSEMIDE 20MG/2ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1940",
            " Charge Amount ": " $7.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90137",
            "Item/Package": "Item",
            "Description": "CEFTRIAXONE(ROCEPHIN) 1 GM VIA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0696",
            " Charge Amount ": " $7.43 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90267",
            "Item/Package": "Item",
            "Description": "FLU VACCINE QS 6MONS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "90658",
            " Charge Amount ": " $8.21 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90154",
            "Item/Package": "Item",
            "Description": "CIPROFLOXACIN (CIPRO) 200 MG/1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0706",
            " Charge Amount ": " $8.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90268",
            "Item/Package": "Item",
            "Description": "FLU VACCINE QS 5YR+/PF",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "90658",
            " Charge Amount ": " $8.47 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90939",
            "Item/Package": "Item",
            "Description": "DEPO MEDROL 20MG/20 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1020",
            " Charge Amount ": " $8.48 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $5.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90435",
            "Item/Package": "Item",
            "Description": "LIDOCAINE MPF 1% 5 ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2001",
            " Charge Amount ": " $9.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90940",
            "Item/Package": "Item",
            "Description": "DEPO MEDROL 40 MG/40MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1030",
            " Charge Amount ": " $10.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90924",
            "Item/Package": "Item",
            "Description": "KENALOG VIAL/10 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3301",
            " Charge Amount ": " $10.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000018",
            "Item/Package": "Item",
            "Description": "MORPHINE 10 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2274",
            " Charge Amount ": " $12.72 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90951",
            "Item/Package": "Item",
            "Description": "VIT B-12 INJ 1000MCG/1000MCG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3420",
            " Charge Amount ": " $13.86 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90350",
            "Item/Package": "Item",
            "Description": "HYDROMORPHONE-PF 10 MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1170",
            " Charge Amount ": " $14.15 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91009",
            "Item/Package": "Item",
            "Description": "DEXAMETHASONE PF 10MG/ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1100",
            " Charge Amount ": " $15.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90107",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE/PF 0.75% 10 ML VIA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3490",
            " Charge Amount ": " $15.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $10.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90614",
            "Item/Package": "Item",
            "Description": "PROPOFOL 10 MG/ML 20MLS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2704",
            " Charge Amount ": " $16.60 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90132",
            "Item/Package": "Item",
            "Description": "CEFEPIME (MAXIPIME) 1GM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0692",
            " Charge Amount ": " $17.96 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $12.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90315",
            "Item/Package": "Item",
            "Description": "GLYCOPYRROLATE (ROBINUL) 0.2 M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3490",
            " Charge Amount ": " $19.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $13.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90779",
            "Item/Package": "Item",
            "Description": "ADENOSINE 6MG/2ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0153",
            " Charge Amount ": " $20.31 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $14.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90093",
            "Item/Package": "Item",
            "Description": "BOTOX 100UNIT VIAL/CHG BY UNIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0585",
            " Charge Amount ": " $22.49 ",
            " Min Reimb ": " $5.43 ",
            " Max Reimb ": " $15.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90886",
            "Item/Package": "Item",
            "Description": "BOTOX 200UNIT VIAL/CHG BY UNIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0585",
            " Charge Amount ": " $22.49 ",
            " Min Reimb ": " $5.43 ",
            " Max Reimb ": " $15.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90941",
            "Item/Package": "Item",
            "Description": "DEPO MEDROL 80MG/80 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1040",
            " Charge Amount ": " $24.38 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90056",
            "Item/Package": "Item",
            "Description": "ATROPINE SULF 0.4MG/ML 1ML VL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0461",
            " Charge Amount ": " $24.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90150",
            "Item/Package": "Item",
            "Description": "CHLORPROMAZINE(THORAZINE) 25 M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3230",
            " Charge Amount ": " $26.84 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $18.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90771",
            "Item/Package": "Item",
            "Description": "ROPIVACAINE HCL INJ 1 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2795",
            " Charge Amount ": " $30.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $21.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91017",
            "Item/Package": "Item",
            "Description": "PRIALT 500MCG 20ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2278",
            " Charge Amount ": " $32.68 ",
            " Min Reimb ": " $7.60 ",
            " Max Reimb ": " $22.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90902",
            "Item/Package": "Item",
            "Description": "CELESTONE 6MG/ML 5ML VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0702",
            " Charge Amount ": " $39.08 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90505",
            "Item/Package": "Item",
            "Description": "MORPHINE SULFATE/PF 1MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2274",
            " Charge Amount ": " $39.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $27.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90716",
            "Item/Package": "Item",
            "Description": "TRIAMCINOLONE ACETONIDE 80 GM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3301",
            " Charge Amount ": " $40.07 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $28.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000013",
            "Item/Package": "Item",
            "Description": "DUROLANE/1MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7318",
            " Charge Amount ": " $42.19 ",
            " Min Reimb ": " $15.43 ",
            " Max Reimb ": " $29.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90242",
            "Item/Package": "Item",
            "Description": "EPINEPHRINE 0.1 MG/ML SYRINGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0171",
            " Charge Amount ": " $42.34 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90055",
            "Item/Package": "Item",
            "Description": "ATROPINE SULFATE 0.1 MG/ML 10",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0461",
            " Charge Amount ": " $47.99 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $33.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90929",
            "Item/Package": "Item",
            "Description": "SYNVISC ONE 48 MG1 1 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7325",
            " Charge Amount ": " $49.54 ",
            " Min Reimb ": " $9.56 ",
            " Max Reimb ": " $34.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91022",
            "Item/Package": "Item",
            "Description": "HYLAN GF 20(SYNVISC1)48MG/6ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7325",
            " Charge Amount ": " $49.64 ",
            " Min Reimb ": " $9.56 ",
            " Max Reimb ": " $34.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90938",
            "Item/Package": "Item",
            "Description": "DENOSUMAB 1MG/1MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0897",
            " Charge Amount ": " $54.06 ",
            " Min Reimb ": " $18.01 ",
            " Max Reimb ": " $37.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000019",
            "Item/Package": "Item",
            "Description": "BUPIVICANIE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3490",
            " Charge Amount ": " $54.06 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $37.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90714",
            "Item/Package": "Item",
            "Description": "TRIAMCINOLONE ACETONIDE 40 MG/",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3301",
            " Charge Amount ": " $57.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $40.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90477",
            "Item/Package": "Item",
            "Description": "DEPOMEDROL METHYLPRED 40MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1030",
            " Charge Amount ": " $60.57 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $42.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000023",
            "Item/Package": "Item",
            "Description": "HYMOVIS 1 MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7322",
            " Charge Amount ": " $64.66 ",
            " Min Reimb ": " $28.37 ",
            " Max Reimb ": " $45.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90479",
            "Item/Package": "Item",
            "Description": "DEPOMEDROL METHYLPRED 80MG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1040",
            " Charge Amount ": " $66.58 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90978",
            "Item/Package": "Item",
            "Description": "QUAD FLU VAC 3YR/0.5ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "90688",
            " Charge Amount ": " $71.67 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $50.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90923",
            "Item/Package": "Item",
            "Description": "SYNVISC 16 MG SYRINGE/ I MG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7325",
            " Charge Amount ": " $76.35 ",
            " Min Reimb ": " $9.56 ",
            " Max Reimb ": " $53.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "906741",
            "Item/Package": "Item",
            "Description": "CCIIV4 VAC NO PRSV 0.5 ML IM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "90674",
            " Charge Amount ": " $103.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $72.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91021",
            "Item/Package": "Item",
            "Description": "MORPHINE SULF/PF 0.5MG/ML AMP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2274",
            " Charge Amount ": " $110.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $77.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90718",
            "Item/Package": "Item",
            "Description": "TRIAMCINOLONE(KENALOG) 10 MG/M",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3301",
            " Charge Amount ": " $114.88 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $80.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90020",
            "Item/Package": "Item",
            "Description": "ALBUTEROL(VENTOLIN HFA) INH 8G",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7609",
            " Charge Amount ": " $122.26 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $85.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90884",
            "Item/Package": "Item",
            "Description": "METHYLENE BLU PROVAY 50MG/10ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "Q9968",
            " Charge Amount ": " $157.43 ",
            " Min Reimb ": " $5.56 ",
            " Max Reimb ": " $110.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90883",
            "Item/Package": "Item",
            "Description": "PAPAVERINE HCL 60MG/2ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2440",
            " Charge Amount ": " $169.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $118.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90918",
            "Item/Package": "Item",
            "Description": "CELESTONE SOLUSPAN 6MG/ML 5ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0702",
            " Charge Amount ": " $209.55 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $146.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90715",
            "Item/Package": "Item",
            "Description": "TRIAMCINOLONE ACETONIDE 40 MG/",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3301",
            " Charge Amount ": " $235.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $165.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "907320",
            "Item/Package": "Item",
            "Description": "PNEUMOCOCCAL IMMUNIZATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "90732",
            " Charge Amount ": " $249.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $174.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000030",
            "Item/Package": "Item",
            "Description": "VACC AII4 NO PRSRV .5ML IM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "90694",
            " Charge Amount ": " $254.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $177.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90002",
            "Item/Package": "Item",
            "Description": "ACETAMINOPHEN (OFIRMEV) 1000",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0131",
            " Charge Amount ": " $257.59 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $180.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90882",
            "Item/Package": "Item",
            "Description": "HYALURONID HYLENEX 150 UNIT/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3473",
            " Charge Amount ": " $286.58 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $200.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90478",
            "Item/Package": "Item",
            "Description": "METHYLPREDNISOLONE ACETATE 80",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1040",
            " Charge Amount ": " $295.79 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $207.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90926",
            "Item/Package": "Item",
            "Description": "HYALGAN/SUPARTZ/DOSE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7321",
            " Charge Amount ": " $437.04 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $305.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90836",
            "Item/Package": "Item",
            "Description": "PHENYL/KETOROLAC OMIDRIA 4ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1097",
            " Charge Amount ": " $489.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $342.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000022",
            "Item/Package": "Item",
            "Description": "Compounded Drug",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7999",
            " Charge Amount ": " $580.81 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $406.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91015",
            "Item/Package": "Item",
            "Description": "HYALURONAT SOD EUFLEXXA 20MG/2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7323",
            " Charge Amount ": " $888.60 ",
            " Min Reimb ": " $55.25 ",
            " Max Reimb ": " $622.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90928",
            "Item/Package": "Item",
            "Description": "ORTHOVISC/DOSE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7324",
            " Charge Amount ": " $898.75 ",
            " Min Reimb ": " $55.25 ",
            " Max Reimb ": " $629.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90876",
            "Item/Package": "Item",
            "Description": "EXPAREL 130MG/10ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "C9290",
            " Charge Amount ": " $901.90 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $631.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90927",
            "Item/Package": "Item",
            "Description": "EUFLEXXA/DOSE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7323",
            " Charge Amount ": " $957.36 ",
            " Min Reimb ": " $55.25 ",
            " Max Reimb ": " $670.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90804",
            "Item/Package": "Item",
            "Description": "MITOMYCIN 40MG VIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J9280",
            " Charge Amount ": " $2,105.16 ",
            " Min Reimb ": " $48.59 ",
            " Max Reimb ": " $1,473.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91008",
            "Item/Package": "Item",
            "Description": "HYALURONATE MOD NCRS 24MG/3ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7322",
            " Charge Amount ": " $2,328.59 ",
            " Min Reimb ": " $28.37 ",
            " Max Reimb ": " $1,630.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91010",
            "Item/Package": "Item",
            "Description": "ZICONOTIDE (PRIALT) 100MCG/ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2278",
            " Charge Amount ": " $2,380.34 ",
            " Min Reimb ": " $7.60 ",
            " Max Reimb ": " $1,666.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91007",
            "Item/Package": "Item",
            "Description": "DUROLANE 60MG/3ML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7318",
            " Charge Amount ": " $2,488.84 ",
            " Min Reimb ": " $15.43 ",
            " Max Reimb ": " $1,742.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "91024",
            "Item/Package": "Item",
            "Description": "QUTENZA 8% PATCH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7336",
            " Charge Amount ": " $2,620.68 ",
            " Min Reimb ": " $2.91 ",
            " Max Reimb ": " $1,834.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90930",
            "Item/Package": "Item",
            "Description": "GEL ONE/DOSE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7326",
            " Charge Amount ": " $3,661.24 ",
            " Min Reimb ": " $325.62 ",
            " Max Reimb ": " $2,562.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90931",
            "Item/Package": "Item",
            "Description": "MONOVISC/DOSE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7327",
            " Charge Amount ": " $3,661.24 ",
            " Min Reimb ": " $593.50 ",
            " Max Reimb ": " $2,562.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100003",
            "Item/Package": "Item",
            "Description": "PACU PHASE II 15 MIN INCREMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "710",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $124.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $86.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100002",
            "Item/Package": "Item",
            "Description": "PACU PHASE II INTIAL 30 MINS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "710",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $501.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $350.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11000013",
            "Item/Package": "Item",
            "Description": "Extended Recovery",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "710",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $726.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $508.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "930050",
            "Item/Package": "Item",
            "Description": "ELECTROCARDIOGRAM TRACING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "730",
            "CPT/HCPCS/DRG": "93005",
            " Charge Amount ": " $212.00 ",
            " Min Reimb ": " $43.57 ",
            " Max Reimb ": " $148.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100102",
            "Item/Package": "Item",
            "Description": "REMOVAL OF ORBERA BALLOON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "ENDOCHG",
            "Item/Package": "Item",
            "Description": "ENDO CHARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "466000",
            "Item/Package": "Item",
            "Description": "ANOSCOPY DIAGNOSTIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $379.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $265.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100088",
            "Item/Package": "Item",
            "Description": "FLEX SIGM CANCER SCREENING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,497.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,047.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "453300",
            "Item/Package": "Item",
            "Description": "SIGMOIDOSCOPY DIAGNOSTIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,497.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,047.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "453310",
            "Item/Package": "Item",
            "Description": "SIGMOIDOSCOPY/FLEXIBLE FOR BX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,497.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,047.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "453350",
            "Item/Package": "Item",
            "Description": "SIGMOIDOSCOPY FLEXIBLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,497.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,047.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "462210",
            "Item/Package": "Item",
            "Description": "LIGATION HEMORRHOIDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,664.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,164.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "434500",
            "Item/Package": "Item",
            "Description": "ESOPHAGEAL DILATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,712.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,198.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "910370",
            "Item/Package": "Item",
            "Description": "ESOPHAGEAL FUNC TEST W/IMPED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,976.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,383.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "432350",
            "Item/Package": "Item",
            "Description": "ENDO UPR GI ESOPH/STOMACH/ETC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,486.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,740.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "432360",
            "Item/Package": "Item",
            "Description": "UP GAST ENDO W/ESOP W/DIR SUBM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,486.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,740.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "432390",
            "Item/Package": "Item",
            "Description": "ENDO UPR GI-BX &/OR SPECIMEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,486.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,740.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "432440",
            "Item/Package": "Item",
            "Description": "UP GAST ENDO W ESOP STM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,486.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,740.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "432450",
            "Item/Package": "Item",
            "Description": "ENDO UP GI-DILITAT FOR OBSTRUC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,486.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,740.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "432460",
            "Item/Package": "Item",
            "Description": "UP GAST-ENDO PLCMNT PERCU TUBE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,486.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,740.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "432470",
            "Item/Package": "Item",
            "Description": "UP GASTRO-ENDO REMOV FB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,486.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,740.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "432480",
            "Item/Package": "Item",
            "Description": "UP GI ENDO/GUIDEWIRE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,486.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,740.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "432490",
            "Item/Package": "Item",
            "Description": "ESOPHAGUS ENDO DILATION5402",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,486.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,740.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "432510",
            "Item/Package": "Item",
            "Description": "ENDO UP GI-REMVL POLYPOID LSNS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,486.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,740.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "453380",
            "Item/Package": "Item",
            "Description": "SIGMOIDOSCOPY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,548.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,783.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "453850",
            "Item/Package": "Item",
            "Description": "COLONOSCOPY W LESION RML",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,587.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,810.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "443890",
            "Item/Package": "Item",
            "Description": "COLONOSCOPY THRU STOMA W BX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,587.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,810.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "443940",
            "Item/Package": "Item",
            "Description": "COLONOSCOPY STOMA W REM SNARE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,587.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,810.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "453400",
            "Item/Package": "Item",
            "Description": "SIG W/TNDSC BALLOON DILATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,587.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,810.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "453780",
            "Item/Package": "Item",
            "Description": "COLONOSCOPY DIAGNOSTIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,587.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,810.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "453800",
            "Item/Package": "Item",
            "Description": "COLONOSCOPY  BX BRUSH WASH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,587.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,810.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "453810",
            "Item/Package": "Item",
            "Description": "COLONOSCOPY SUBMUCOUS INJ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,587.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,810.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "453820",
            "Item/Package": "Item",
            "Description": "COLONOSCOPY W CONTR BLEEDING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,587.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,810.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "453840",
            "Item/Package": "Item",
            "Description": "COLONOSCOPY W POLYPECTOMY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,587.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,810.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "453860",
            "Item/Package": "Item",
            "Description": "COLONOSCOPY/DILATION BALLOON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,587.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,810.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "453900",
            "Item/Package": "Item",
            "Description": "COLONOSCOPY FLX W ENDO RESECT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,587.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,810.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "443880",
            "Item/Package": "Item",
            "Description": "FIBEROPTIC COLON THR COLOS/STO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,808.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,965.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "453880",
            "Item/Package": "Item",
            "Description": "COLON FLX ABL TUMOR POLYP/LES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,820.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,973.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100026",
            "Item/Package": "Item",
            "Description": "SCREENING COLONOSCOPY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,847.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,992.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100028",
            "Item/Package": "Item",
            "Description": "SCRN COLONOSCOP NOT HIGH RISK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,847.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,992.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "910100",
            "Item/Package": "Item",
            "Description": "ESOPHAGUS MOTILITY/ MANOMETRY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,896.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,027.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "432700",
            "Item/Package": "Item",
            "Description": "EGD LESION ABLATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,963.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,074.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "910350",
            "Item/Package": "Item",
            "Description": "G-ESOPH REFLX TST W/BRAVO",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3,358.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,350.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "432550",
            "Item/Package": "Item",
            "Description": "EGD CONTR0L BLEEDING ANY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4,012.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,808.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "432290",
            "Item/Package": "Item",
            "Description": "ESOPHAGOSCOPY LESION ABLATE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $4,411.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3,087.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "459900",
            "Item/Package": "Item",
            "Description": "ANORECTAL  SURG REQ ANES DX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "750",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $6,650.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4,655.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "PAINCHG",
            "Item/Package": "Item",
            "Description": "PAIN CHARGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "963720",
            "Item/Package": "Item",
            "Description": "THER/PROPH/DIAG INJ SC IM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "96372",
            " Charge Amount ": " $110.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $77.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100104",
            "Item/Package": "Item",
            "Description": "Hospital Clinic Visit I",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "G0463",
            " Charge Amount ": " $174.00 ",
            " Min Reimb ": " $60.07 ",
            " Max Reimb ": " $121.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100103",
            "Item/Package": "Item",
            "Description": "Hospital Clinic Visit II",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "G0463",
            " Charge Amount ": " $290.00 ",
            " Min Reimb ": " $60.07 ",
            " Max Reimb ": " $203.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "517980",
            "Item/Package": "Item",
            "Description": "US PV RESIDUAL URINE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "51798",
            " Charge Amount ": " $292.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $204.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "951990",
            "Item/Package": "Item",
            "Description": "ALLERGY/CLINICAL IMMUNOL UNLST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "95199",
            " Charge Amount ": " $292.00 ",
            " Min Reimb ": " $22.10 ",
            " Max Reimb ": " $204.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "192850",
            "Item/Package": "Item",
            "Description": "PERQ DEV BREAST IST US IMAG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "19285",
            " Charge Amount ": " $392.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $274.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "623700",
            "Item/Package": "Item",
            "Description": "ELC ANLY REPRG & REFILL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "62370",
            " Charge Amount ": " $462.00 ",
            " Min Reimb ": " $171.10 ",
            " Max Reimb ": " $323.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "646150",
            "Item/Package": "Item",
            "Description": "CHEMO DENERV MUSC BILAT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "64615",
            " Charge Amount ": " $573.00 ",
            " Min Reimb ": " $233.98 ",
            " Max Reimb ": " $401.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206000",
            "Item/Package": "Item",
            "Description": "INJ SMALL JNT FINGER/TOE LT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205260",
            "Item/Package": "Item",
            "Description": "INJ THERA CARPAL TUNNEL LT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $683.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $478.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205262",
            "Item/Package": "Item",
            "Description": "INJ THERA CARPAL TUNNEL RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $683.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $478.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205500",
            "Item/Package": "Item",
            "Description": "INJ TRIGGER PT TENDON SHEATH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205510",
            "Item/Package": "Item",
            "Description": "INJ TENDON ORIGIN/INSERTION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205520",
            "Item/Package": "Item",
            "Description": "TRIGGER POINT 1-2 MUSC GRPS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "290650",
            "Item/Package": "Item",
            "Description": "APPLY LONG ARM CAST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29065",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "290750",
            "Item/Package": "Item",
            "Description": "APLLY SHORT ARM CAST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29075",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "291050",
            "Item/Package": "Item",
            "Description": "APPLY LONG ARM SPLINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29105",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "291250",
            "Item/Package": "Item",
            "Description": "APPLY SHORT ARM SPLINT STATIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29125",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "291300",
            "Item/Package": "Item",
            "Description": "APPLY FINGER SPLINT STATIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29130",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "294250",
            "Item/Package": "Item",
            "Description": "APPLY WLKR SH LEG CAST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29425",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "295150",
            "Item/Package": "Item",
            "Description": "APPLY SHORT LEG SPLINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29515",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205530",
            "Item/Package": "Item",
            "Description": "TRIGGER POINT 3/ MORE MUSC GRP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $683.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $478.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "964010",
            "Item/Package": "Item",
            "Description": "CHEMO ANTI-NEOPL SQ/IM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "96401",
            " Charge Amount ": " $688.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $481.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206040",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ SMALL JOINT/BUR W/US",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $812.00 ",
            " Min Reimb ": " $233.98 ",
            " Max Reimb ": " $568.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206110",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ MAJ JOINT/BURSA W/US",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $812.00 ",
            " Min Reimb ": " $233.98 ",
            " Max Reimb ": " $568.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "387920",
            "Item/Package": "Item",
            "Description": "INJ PROCED ID SENTINEL NODE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $876.00 ",
            " Min Reimb ": " $250.12 ",
            " Max Reimb ": " $613.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206050",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ JOINT/BURSA LT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206100",
            "Item/Package": "Item",
            "Description": "ARTHRO MAJOR JOINT/BURSA LT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206108",
            "Item/Package": "Item",
            "Description": "ARTHRO MAJOR JOINT/BURSA RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "646430",
            "Item/Package": "Item",
            "Description": "CHEMODENER 1 EXT EA ADDL 1-4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "64643",
            " Charge Amount ": " $928.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $649.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "646160",
            "Item/Package": "Item",
            "Description": "CHEMODENERV MUSC NECK DYSTON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,012.00 ",
            " Min Reimb ": " $233.98 ",
            " Max Reimb ": " $708.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205504",
            "Item/Package": "Item",
            "Description": "INJ TRGGER PT TENDON SHEATH BL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,021.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $714.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "623680",
            "Item/Package": "Item",
            "Description": "ELECTRONIC ANLY REPROGRAMMING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "62368",
            " Charge Amount ": " $936.00 ",
            " Min Reimb ": " $171.10 ",
            " Max Reimb ": " $655.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205264",
            "Item/Package": "Item",
            "Description": "INJ THERA CARPAL TUNNEL BL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,024.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $716.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206008",
            "Item/Package": "Item",
            "Description": "INJ SMALL JNT FINGER/TOE RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206058",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ JOINT/BURSA RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "0232T",
            "Item/Package": "Item",
            "Description": "NJX PLATELET PLASMA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "0232T",
            " Charge Amount ": " $983.00 ",
            " Min Reimb ": " $242.09 ",
            " Max Reimb ": " $688.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "646420",
            "Item/Package": "Item",
            "Description": "CHEMODENERV 1 EXTR  1-4  MUSC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "64642",
            " Charge Amount ": " $1,186.00 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $830.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "646440",
            "Item/Package": "Item",
            "Description": "CHEMODENERV 1 EXTR 5> MUSC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "64644",
            " Charge Amount ": " $1,428.00 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $999.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "646450",
            "Item/Package": "Item",
            "Description": "CHEMODENERV 1 EXTREM 5/> EA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "64645",
            " Charge Amount ": " $928.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $649.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206054",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ JOINT/BURSA BL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,021.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $714.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206104",
            "Item/Package": "Item",
            "Description": "ARTHRO MAJOR JOINT OR BURSA BL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,021.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $714.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644150",
            "Item/Package": "Item",
            "Description": "INJ NERVE BLOCK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,403.00 ",
            " Min Reimb ": " $588.77 ",
            " Max Reimb ": " $982.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644170",
            "Item/Package": "Item",
            "Description": "INJ ANES AGENT AXIL NERVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,403.00 ",
            " Min Reimb ": " $588.77 ",
            " Max Reimb ": " $982.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644180",
            "Item/Package": "Item",
            "Description": "INJ NERVE BLOCK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,403.00 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $982.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644200",
            "Item/Package": "Item",
            "Description": "INJ NERVE BLOCK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,403.00 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $982.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644210",
            "Item/Package": "Item",
            "Description": "INJ NERVE BLOCK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,403.00 ",
            " Min Reimb ": " $588.77 ",
            " Max Reimb ": " $982.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644250",
            "Item/Package": "Item",
            "Description": "INJ NERVE BLOCK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,403.00 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $982.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644000",
            "Item/Package": "Item",
            "Description": "INJ ANESTH TRIGEMINAL NERVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,450.00 ",
            " Min Reimb ": " $233.98 ",
            " Max Reimb ": " $1,014.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206004",
            "Item/Package": "Item",
            "Description": "INJ SMALL JNT FINGER/TOE BL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,021.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $714.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644800",
            "Item/Package": "Item",
            "Description": "INJ AGNT TRANSFOR CER/THOR ADD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,671.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,169.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644840",
            "Item/Package": "Item",
            "Description": "INJ AGENT LUMBAR/SACRAL ADD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,671.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,169.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644910",
            "Item/Package": "Item",
            "Description": "INJ PARAVERT F JNT C/T 2ND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,671.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,169.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644920",
            "Item/Package": "Item",
            "Description": "INJ PARAVERT F JNT C/T 3RD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,671.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,169.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644940",
            "Item/Package": "Item",
            "Description": "INJ PARAVERT LUMBAR/SACRAL 2ND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,745.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,221.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644950",
            "Item/Package": "Item",
            "Description": "INJ PARAVERT LUMBAR/SACRAL 3RD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,745.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,221.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100098",
            "Item/Package": "Item",
            "Description": "FNA W CT 1ST LES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,897.00 ",
            " Min Reimb ": " $545.86 ",
            " Max Reimb ": " $1,327.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100108",
            "Item/Package": "Item",
            "Description": "FNA W CT EA ADDL LES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,897.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,327.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "192812",
            "Item/Package": "Item",
            "Description": "MM NEEDLE LOC LT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,967.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,376.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "192813",
            "Item/Package": "Item",
            "Description": "MM NEEDLE LOC RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,967.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,376.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "623200",
            "Item/Package": "Item",
            "Description": "INJ INTERLAMINAR CRV/THRC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,064.00 ",
            " Min Reimb ": " $568.53 ",
            " Max Reimb ": " $1,444.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "623220",
            "Item/Package": "Item",
            "Description": "INJ INTERLAMINAR LMBR/SAC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,064.00 ",
            " Min Reimb ": " $568.53 ",
            " Max Reimb ": " $1,444.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644050",
            "Item/Package": "Item",
            "Description": "INJ NERVE BLOCK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,064.00 ",
            " Min Reimb ": " $233.98 ",
            " Max Reimb ": " $1,444.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644450",
            "Item/Package": "Item",
            "Description": "INJ NERVE BLOCK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,064.00 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $1,444.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644500",
            "Item/Package": "Item",
            "Description": "INJ NERVE BLOCK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,064.00 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $1,444.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644830",
            "Item/Package": "Item",
            "Description": "INJ FORAMEN EPIDURAL L/S",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,064.00 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $1,444.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644900",
            "Item/Package": "Item",
            "Description": "INJ PARAVERT F JNT C/T 1 LVL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,064.00 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $1,444.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644930",
            "Item/Package": "Item",
            "Description": "INJ PARAVERT F JNT L/S 1 LVL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,064.00 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $1,444.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "645100",
            "Item/Package": "Item",
            "Description": "INJ STELLATE GANGLION/CERVICAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,064.00 ",
            " Min Reimb ": " $588.77 ",
            " Max Reimb ": " $1,444.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "645200",
            "Item/Package": "Item",
            "Description": "INJ ANES LUM/THOR SYMPATHETIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,064.00 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $1,444.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644470",
            "Item/Package": "Item",
            "Description": "INJ FEMORAL NB SINGLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,064.00 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $1,444.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "G0260",
            "Item/Package": "Item",
            "Description": "INJ PROC SACROLILAC JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,070.00 ",
            " Min Reimb ": " $426.37 ",
            " Max Reimb ": " $1,449.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644880",
            "Item/Package": "Item",
            "Description": "TAP BLOCK BL INJECTION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,305.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,613.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644860",
            "Item/Package": "Item",
            "Description": "TAP BLOCK UNIL BY INJ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,331.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,631.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "623210",
            "Item/Package": "Item",
            "Description": "INJ INTERLAM CRV/THRC W/IMAGIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,399.00 ",
            " Min Reimb ": " $568.53 ",
            " Max Reimb ": " $1,679.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "623230",
            "Item/Package": "Item",
            "Description": "INJ INTERLAM LMBR/SAC W/IMAGIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,399.00 ",
            " Min Reimb ": " $568.53 ",
            " Max Reimb ": " $1,679.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "623250",
            "Item/Package": "Item",
            "Description": "INJ INTERLAM CRV/THRC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,745.00 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $1,921.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "623270",
            "Item/Package": "Item",
            "Description": "INJ INTERLAM LMBR/SAC W IMG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,745.00 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $1,921.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "470000",
            "Item/Package": "Item",
            "Description": "CT BIOPSY LIVER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,913.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,039.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "202060",
            "Item/Package": "Item",
            "Description": "BX MUSCLE PERC NEEDLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,780.00 ",
            " Min Reimb ": " $545.86 ",
            " Max Reimb ": " $1,945.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "646340",
            "Item/Package": "Item",
            "Description": "DESTROY C/TH FACET JNT ADDL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,832.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,982.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "646360",
            "Item/Package": "Item",
            "Description": "DESTROY L/S FACET JNT ADDL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,832.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,982.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "202200",
            "Item/Package": "Item",
            "Description": "CT GUIDED BONE SUPERFICIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,853.00 ",
            " Min Reimb ": " $545.86 ",
            " Max Reimb ": " $1,997.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "646400",
            "Item/Package": "Item",
            "Description": "DESTR W NEU OTH PERIPH NRV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $2,961.00 ",
            " Min Reimb ": " $588.77 ",
            " Max Reimb ": " $2,072.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "491800",
            "Item/Package": "Item",
            "Description": "CTBIOPSY ABDOMEN PERCUTANEOUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "49180",
            " Charge Amount ": " $3,001.00 ",
            " Min Reimb ": " $525.31 ",
            " Max Reimb ": " $2,100.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "365690",
            "Item/Package": "Item",
            "Description": "INS PICC AGE 5 YRS />",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "36569",
            " Charge Amount ": " $3,096.00 ",
            " Min Reimb ": " $526.06 ",
            " Max Reimb ": " $2,167.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "365730",
            "Item/Package": "Item",
            "Description": "INS PICC W/RS&I 5YRS>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "36573",
            " Charge Amount ": " $3,096.00 ",
            " Min Reimb ": " $526.06 ",
            " Max Reimb ": " $2,167.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "649990",
            "Item/Package": "Item",
            "Description": "Unl Procedure Nervous System",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3,131.00 ",
            " Min Reimb ": " $233.98 ",
            " Max Reimb ": " $2,191.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "503900",
            "Item/Package": "Item",
            "Description": "PERC ASP/INJ OF RENAL CYST/PEL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3,154.00 ",
            " Min Reimb ": " $338.74 ",
            " Max Reimb ": " $2,207.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644510",
            "Item/Package": "Item",
            "Description": "INJ NRV SI JNT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3,154.00 ",
            " Min Reimb ": " $426.37 ",
            " Max Reimb ": " $2,207.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644540",
            "Item/Package": "Item",
            "Description": "INJ GNCLR NRV BR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3,154.00 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $2,207.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "270960",
            "Item/Package": "Item",
            "Description": "INJ PROC SACROILIAC JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "511020",
            "Item/Package": "Item",
            "Description": "DRAIN BLAD W CATH INSERT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "51102",
            " Charge Amount ": " $3,286.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,300.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644790",
            "Item/Package": "Item",
            "Description": "INJ FORAMEN EQIDURAL C/T",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $3,405.00 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $2,383.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "610700",
            "Item/Package": "Item",
            "Description": "Punct Shunt Rsvr Asp/Inj",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "61070",
            " Charge Amount ": " $3,591.00 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $2,513.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "622640",
            "Item/Package": "Item",
            "Description": "Lysis Of Adh Ulti 1 Day",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "62264",
            " Charge Amount ": " $3,982.00 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $2,787.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "646330",
            "Item/Package": "Item",
            "Description": "DESTROY CERV/THOR FACET JNT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "64633",
            " Charge Amount ": " $4,062.00 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $2,843.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "646350",
            "Item/Package": "Item",
            "Description": "DESTROY LUMB/SAC FACET JNT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "64635",
            " Charge Amount ": " $4,062.00 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $2,843.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "646240",
            "Item/Package": "Item",
            "Description": "DEST GNCLR NRV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "64624",
            " Charge Amount ": " $4,214.00 ",
            " Min Reimb ": " $588.77 ",
            " Max Reimb ": " $2,949.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "646250",
            "Item/Package": "Item",
            "Description": "RF ABLT NRV SI JNT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "64625",
            " Charge Amount ": " $4,214.00 ",
            " Min Reimb ": " $1,049.80 ",
            " Max Reimb ": " $2,949.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "171100",
            "Item/Package": "Item",
            "Description": "Wart Removal 14 or Less",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5,339.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3,737.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "171110",
            "Item/Package": "Item",
            "Description": "Wart Removal 15 or More",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $5,339.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3,737.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "636500",
            "Item/Package": "Item",
            "Description": "PERC STIM TRIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $8,649.00 ",
            " Min Reimb ": " $1,998.49 ",
            " Max Reimb ": " $6,054.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11000012",
            "Item/Package": "Item",
            "Description": "Observation each addtl 30 min",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "762",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $51.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $35.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "11000011",
            "Item/Package": "Item",
            "Description": "Observation 1st 60min (per30)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "762",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $243.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $170.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7010",
            "Item/Package": "Item",
            "Description": "ADMIN PNEUMONIA VACCINE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "771",
            "CPT/HCPCS/DRG": "G0009",
            " Charge Amount ": " $94.00 ",
            " Min Reimb ": " $35.84 ",
            " Max Reimb ": " $65.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7008",
            "Item/Package": "Item",
            "Description": "ADMIN FLU VIRUS VACCINE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "771",
            "CPT/HCPCS/DRG": "G0008",
            " Charge Amount ": " $106.00 ",
            " Min Reimb ": " $35.84 ",
            " Max Reimb ": " $74.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "904710",
            "Item/Package": "Item",
            "Description": "IMMUNIZATION ADMIN 1 VACCINE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "771",
            "CPT/HCPCS/DRG": "90471",
            " Charge Amount ": " $222.00 ",
            " Min Reimb ": " $54.71 ",
            " Max Reimb ": " $155.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "505900",
            "Item/Package": "Item",
            "Description": "LITHOT EXTRACORP SHOCK WAV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "790",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7,135.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4,994.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "959720",
            "Item/Package": "Item",
            "Description": "ANALYZE NEUROSTIM COMPLEX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95972",
            " Charge Amount ": " $444.00 ",
            " Min Reimb ": " $89.87 ",
            " Max Reimb ": " $310.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939700",
            "Item/Package": "Item",
            "Description": "DUPLEX EXT VEINS BILAT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93970",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $206.17 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939704",
            "Item/Package": "Item",
            "Description": "US VENOUS DOPPLER LE BI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93970",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $206.17 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939712",
            "Item/Package": "Item",
            "Description": "US VENOUS DOPPLER LE LT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93971",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939713",
            "Item/Package": "Item",
            "Description": "US VENOUS DOPPLER LE RT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93971",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958740",
            "Item/Package": "Item",
            "Description": "NEEDLE EMG GUIDANCE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "922",
            "CPT/HCPCS/DRG": "95874",
            " Charge Amount ": " $717.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $501.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958860",
            "Item/Package": "Item",
            "Description": "NEEDLE EMG EA EXT W/PARASPIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "922",
            "CPT/HCPCS/DRG": "95886",
            " Charge Amount ": " $1,347.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $942.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "959100",
            "Item/Package": "Item",
            "Description": "NERVE CONDSTD 7-8 STDY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "922",
            "CPT/HCPCS/DRG": "95910",
            " Charge Amount ": " $3,115.00 ",
            " Min Reimb ": " $236.92 ",
            " Max Reimb ": " $2,180.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "959110",
            "Item/Package": "Item",
            "Description": "NERVE CONDSTD 9-10 STDY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "922",
            "CPT/HCPCS/DRG": "95911",
            " Charge Amount ": " $3,999.00 ",
            " Min Reimb ": " $308.48 ",
            " Max Reimb ": " $2,799.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "959120",
            "Item/Package": "Item",
            "Description": "NERVE CONDSTD11-12 STDY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "922",
            "CPT/HCPCS/DRG": "95912",
            " Charge Amount ": " $4,888.00 ",
            " Min Reimb ": " $308.48 ",
            " Max Reimb ": " $3,421.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "959130",
            "Item/Package": "Item",
            "Description": "NERVE CONDSTD 13 +",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "922",
            "CPT/HCPCS/DRG": "95913",
            " Charge Amount ": " $5,205.00 ",
            " Min Reimb ": " $308.48 ",
            " Max Reimb ": " $3,643.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "STOMACH, ESOPHAGEAL & DUODENAL PROC W CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "327",
            " Charge Amount ": " $42,833.02 ",
            " Min Reimb ": " $13,733.11 ",
            " Max Reimb ": " $29,983.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "STOMACH, ESOPHAGEAL & DUODENAL PROC W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "328",
            " Charge Amount ": " $34,649.71 ",
            " Min Reimb ": " $8,406.72 ",
            " Max Reimb ": " $24,254.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "329",
            " Charge Amount ": " $43,423.81 ",
            " Min Reimb ": " $26,192.67 ",
            " Max Reimb ": " $30,396.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MAJOR SMALL & LARGE BOWEL PROCEDURES W CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "330",
            " Charge Amount ": " $49,841.18 ",
            " Min Reimb ": " $13,487.05 ",
            " Max Reimb ": " $34,888.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "331",
            " Charge Amount ": " $48,056.16 ",
            " Min Reimb ": " $9,016.27 ",
            " Max Reimb ": " $33,639.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PERITONEAL ADHESIOLYSIS W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "337",
            " Charge Amount ": " $40,130.66 ",
            " Min Reimb ": " $8,752.06 ",
            " Max Reimb ": " $28,091.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ANAL & STOMAL PROCEDURES W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "349",
            " Charge Amount ": " $27,333.78 ",
            " Min Reimb ": " $5,235.65 ",
            " Max Reimb ": " $19,133.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "OTHER DIGESTIVE SYSTEM DIAGNOSES W CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "394",
            " Charge Amount ": " $29,504.27 ",
            " Min Reimb ": " $5,007.20 ",
            " Max Reimb ": " $20,652.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "453",
            " Charge Amount ": " $215,824.02 ",
            " Min Reimb ": " $50,210.80 ",
            " Max Reimb ": " $151,076.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "454",
            " Charge Amount ": " $177,360.33 ",
            " Min Reimb ": " $32,692.80 ",
            " Max Reimb ": " $124,152.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "455",
            " Charge Amount ": " $150,577.66 ",
            " Min Reimb ": " $25,691.47 ",
            " Max Reimb ": " $105,404.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "458",
            " Charge Amount ": " $235,251.46 ",
            " Min Reimb ": " $25,054.16 ",
            " Max Reimb ": " $164,676.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SPINAL FUSION EXCEPT CERVICAL W/O MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "460",
            " Charge Amount ": " $127,020.56 ",
            " Min Reimb ": " $21,139.03 ",
            " Max Reimb ": " $88,914.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "462",
            " Charge Amount ": " $73,705.75 ",
            " Min Reimb ": " $16,740.85 ",
            " Max Reimb ": " $51,594.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "465",
            " Charge Amount ": " $52,780.59 ",
            " Min Reimb ": " $10,222.57 ",
            " Max Reimb ": " $36,946.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISION OF HIP OR KNEE REPLACEMENT W CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "467",
            " Charge Amount ": " $90,623.81 ",
            " Min Reimb ": " $18,746.18 ",
            " Max Reimb ": " $63,436.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "468",
            " Charge Amount ": " $44,110.26 ",
            " Min Reimb ": " $15,009.86 ",
            " Max Reimb ": " $30,877.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC OR TOTAL ANKLE REPLACEMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "469",
            " Charge Amount ": " $46,056.10 ",
            " Min Reimb ": " $16,759.53 ",
            " Max Reimb ": " $32,239.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "470",
            " Charge Amount ": " $45,544.11 ",
            " Min Reimb ": " $10,506.53 ",
            " Max Reimb ": " $31,880.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CERVICAL SPINAL FUSION W MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "471",
            " Charge Amount ": " $75,881.47 ",
            " Min Reimb ": " $26,658.11 ",
            " Max Reimb ": " $53,117.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CERVICAL SPINAL FUSION W CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "472",
            " Charge Amount ": " $81,636.75 ",
            " Min Reimb ": " $16,234.31 ",
            " Max Reimb ": " $57,145.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CERVICAL SPINAL FUSION W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "473",
            " Charge Amount ": " $58,424.95 ",
            " Min Reimb ": " $13,410.19 ",
            " Max Reimb ": " $40,897.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "475",
            " Charge Amount ": " $30,477.51 ",
            " Min Reimb ": " $11,214.30 ",
            " Max Reimb ": " $21,334.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "478",
            " Charge Amount ": " $41,092.74 ",
            " Min Reimb ": " $12,367.75 ",
            " Max Reimb ": " $28,764.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "479",
            " Charge Amount ": " $34,815.90 ",
            " Min Reimb ": " $9,512.14 ",
            " Max Reimb ": " $24,371.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "482",
            " Charge Amount ": " $42,115.58 ",
            " Min Reimb ": " $8,781.95 ",
            " Max Reimb ": " $29,480.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "483",
            " Charge Amount ": " $50,533.89 ",
            " Min Reimb ": " $12,768.07 ",
            " Max Reimb ": " $35,373.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "KNEE PROCEDURES W/O PDX OF INFECTION W CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "488",
            " Charge Amount ": " $46,608.54 ",
            " Min Reimb ": " $10,510.80 ",
            " Max Reimb ": " $32,625.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "KNEE PROCEDURES W/O PDX OF INFECTION W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "489",
            " Charge Amount ": " $36,002.51 ",
            " Min Reimb ": " $6,720.04 ",
            " Max Reimb ": " $25,201.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "516",
            " Charge Amount ": " $50,971.72 ",
            " Min Reimb ": " $10,350.14 ",
            " Max Reimb ": " $35,680.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "517",
            " Charge Amount ": " $37,304.36 ",
            " Min Reimb ": " $7,554.31 ",
            " Max Reimb ": " $26,113.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BACK & NECK PROC EXC SPINAL FUSION W MCC OR DISC DEVICE/NEUROSTIM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "518",
            " Charge Amount ": " $49,654.76 ",
            " Min Reimb ": " $18,193.74 ",
            " Max Reimb ": " $34,758.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BACK & NECK PROC EXC SPINAL FUSION W CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "519",
            " Charge Amount ": " $40,468.72 ",
            " Min Reimb ": " $10,187.88 ",
            " Max Reimb ": " $28,328.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "520",
            " Charge Amount ": " $40,054.42 ",
            " Min Reimb ": " $7,141.71 ",
            " Max Reimb ": " $28,038.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MEDICAL BACK PROBLEMS W/O MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "552",
            " Charge Amount ": " $131,599.43 ",
            " Min Reimb ": " $4,867.36 ",
            " Max Reimb ": " $92,119.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BONE DISEASES & ARTHROPATHIES W/O MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "554",
            " Charge Amount ": " $42,708.42 ",
            " Min Reimb ": " $4,201.76 ",
            " Max Reimb ": " $29,895.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W/O MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "556",
            " Charge Amount ": " $7,719.20 ",
            " Min Reimb ": " $4,226.31 ",
            " Max Reimb ": " $5,403.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "581",
            " Charge Amount ": " $37,506.56 ",
            " Min Reimb ": " $6,697.62 ",
            " Max Reimb ": " $26,254.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MAJOR BLADDER PROCEDURES W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "655",
            " Charge Amount ": " $35,390.88 ",
            " Min Reimb ": " $11,008.27 ",
            " Max Reimb ": " $24,773.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "661",
            " Charge Amount ": " $34,817.52 ",
            " Min Reimb ": " $5,818.52 ",
            " Max Reimb ": " $24,372.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "OTHER KIDNEY & URINARY TRACT PROCEDURES W CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "674",
            " Charge Amount ": " $60,671.77 ",
            " Min Reimb ": " $13,046.16 ",
            " Max Reimb ": " $42,470.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MAJOR MALE PELVIC PROCEDURES W CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "707",
            " Charge Amount ": " $58,634.22 ",
            " Min Reimb ": " $9,980.78 ",
            " Max Reimb ": " $41,043.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MAJOR MALE PELVIC PROCEDURES W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "708",
            " Charge Amount ": " $51,796.85 ",
            " Min Reimb ": " $7,750.20 ",
            " Max Reimb ": " $36,257.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "718",
            " Charge Amount ": " $60,086.65 ",
            " Min Reimb ": " $6,508.67 ",
            " Max Reimb ": " $42,060.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "738",
            " Charge Amount ": " $28,942.32 ",
            " Min Reimb ": " $7,360.02 ",
            " Max Reimb ": " $20,259.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "742",
            " Charge Amount ": " $29,654.48 ",
            " Min Reimb ": " $9,017.88 ",
            " Max Reimb ": " $20,758.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "743",
            " Charge Amount ": " $27,150.48 ",
            " Min Reimb ": " $6,130.23 ",
            " Max Reimb ": " $19,005.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "VAGINA, CERVIX & VULVA PROCEDURES W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "747",
            " Charge Amount ": " $24,459.19 ",
            " Min Reimb ": " $4,975.71 ",
            " Max Reimb ": " $17,121.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "857",
            " Charge Amount ": " $45,428.10 ",
            " Min Reimb ": " $10,852.94 ",
            " Max Reimb ": " $31,799.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "OTHER O.R. PROCEDURES FOR INJURIES W CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "908",
            " Charge Amount ": " $19,862.41 ",
            " Min Reimb ": " $11,012.00 ",
            " Max Reimb ": " $13,903.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "OTHER O.R. PROCEDURES FOR INJURIES W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "909",
            " Charge Amount ": " $22,392.45 ",
            " Min Reimb ": " $7,038.69 ",
            " Max Reimb ": " $15,674.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "941",
            " Charge Amount ": " $14,717.73 ",
            " Min Reimb ": " $10,305.30 ",
            " Max Reimb ": " $10,302.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "982",
            " Charge Amount ": " $79,731.26 ",
            " Min Reimb ": " $13,013.07 ",
            " Max Reimb ": " $55,811.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "983",
            " Charge Amount ": " $30,343.08 ",
            " Min Reimb ": " $8,738.18 ",
            " Max Reimb ": " $21,240.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "FNA BX W/CT GDN 1ST LES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "10009",
            " Charge Amount ": " $5,686.52 ",
            " Min Reimb ": " $545.86 ",
            " Max Reimb ": " $3,980.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "GUIDE CATHET FLUID DRAINAGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "10030",
            " Charge Amount ": " $3,990.68 ",
            " Min Reimb ": " $557.22 ",
            " Max Reimb ": " $2,793.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DRAINAGE OF SKIN ABSCESS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "10060",
            " Charge Amount ": " $5,111.91 ",
            " Min Reimb ": " $160.86 ",
            " Max Reimb ": " $3,578.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DRAINAGE OF SKIN ABSCESS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "10061",
            " Charge Amount ": " $5,102.53 ",
            " Min Reimb ": " $201.91 ",
            " Max Reimb ": " $3,571.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DRAINAGE OF PILONIDAL CYST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "10080",
            " Charge Amount ": " $4,684.48 ",
            " Min Reimb ": " $201.91 ",
            " Max Reimb ": " $3,279.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DRAINAGE OF PILONIDAL CYST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "10081",
            " Charge Amount ": " $4,242.66 ",
            " Min Reimb ": " $557.22 ",
            " Max Reimb ": " $2,969.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE FOREIGN BODY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "10120",
            " Charge Amount ": " $4,390.46 ",
            " Min Reimb ": " $201.91 ",
            " Max Reimb ": " $3,073.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE FOREIGN BODY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "10121",
            " Charge Amount ": " $5,929.74 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $4,150.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DRAINAGE OF HEMATOMA/FLUID",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "10140",
            " Charge Amount ": " $6,203.85 ",
            " Min Reimb ": " $686.59 ",
            " Max Reimb ": " $4,342.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DEB SUBQ TISSUE 20 SQ CM/<",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11042",
            " Charge Amount ": " $12,261.23 ",
            " Min Reimb ": " $309.84 ",
            " Max Reimb ": " $8,582.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DEB MUSC/FASCIA 20 SQ CM/<",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11043",
            " Charge Amount ": " $13,606.74 ",
            " Min Reimb ": " $469.60 ",
            " Max Reimb ": " $9,524.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DEB BONE 20 SQ CM/<",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11044",
            " Charge Amount ": " $23,987.56 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $16,791.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TANGNTL BX SKIN SINGLE LES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11102",
            " Charge Amount ": " $5,990.94 ",
            " Min Reimb ": " $160.86 ",
            " Max Reimb ": " $4,193.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INCAL BX SKN SINGLE LES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11106",
            " Charge Amount ": " $13,691.67 ",
            " Min Reimb ": " $469.60 ",
            " Max Reimb ": " $9,584.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF SKIN TAGS <W/15",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11200",
            " Charge Amount ": " $4,986.55 ",
            " Min Reimb ": " $160.86 ",
            " Max Reimb ": " $3,490.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SHAVE SKIN LESION 1.1-2.0 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11307",
            " Charge Amount ": " $9,711.71 ",
            " Min Reimb ": " $160.86 ",
            " Max Reimb ": " $6,798.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC TR-EXT B9+MARG 0.6-1 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11401",
            " Charge Amount ": " $6,873.30 ",
            " Min Reimb ": " $309.84 ",
            " Max Reimb ": " $4,811.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC TR-EXT B9+MARG 1.1-2 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11402",
            " Charge Amount ": " $7,524.37 ",
            " Min Reimb ": " $557.22 ",
            " Max Reimb ": " $5,267.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC TR-EXT B9+MARG 2.1-3CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11403",
            " Charge Amount ": " $6,259.09 ",
            " Min Reimb ": " $557.22 ",
            " Max Reimb ": " $4,381.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC TR-EXT B9+MARG 3.1-4 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11404",
            " Charge Amount ": " $7,264.23 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $5,084.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC TR-EXT B9+MARG >4.0 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11406",
            " Charge Amount ": " $10,422.76 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $7,295.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC H-F-NK-SP B9+MARG 0.6-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11421",
            " Charge Amount ": " $7,255.28 ",
            " Min Reimb ": " $557.22 ",
            " Max Reimb ": " $5,078.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC H-F-NK-SP B9+MARG 1.1-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11422",
            " Charge Amount ": " $5,778.56 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $4,044.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC H-F-NK-SP B9+MARG 2.1-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11423",
            " Charge Amount ": " $7,223.49 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $5,056.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC H-F-NK-SP B9+MARG 3.1-4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11424",
            " Charge Amount ": " $9,151.90 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $6,406.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC H-F-NK-SP B9+MARG >4 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11426",
            " Charge Amount ": " $10,989.76 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $7,692.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FACE-MM B9+MARG 0.5 CM/<",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11440",
            " Charge Amount ": " $4,941.01 ",
            " Min Reimb ": " $557.22 ",
            " Max Reimb ": " $3,458.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FACE-MM B9+MARG 0.6-1 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11441",
            " Charge Amount ": " $10,926.16 ",
            " Min Reimb ": " $557.22 ",
            " Max Reimb ": " $7,648.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FACE-MM B9+MARG 1.1-2 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11442",
            " Charge Amount ": " $8,459.77 ",
            " Min Reimb ": " $557.22 ",
            " Max Reimb ": " $5,921.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FACE-MM B9+MARG 2.1-3 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11443",
            " Charge Amount ": " $8,654.87 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $6,058.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FACE-MM B9+MARG 3.1-4 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11444",
            " Charge Amount ": " $11,539.40 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $8,077.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FACE-MM B9+MARG >4 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11446",
            " Charge Amount ": " $9,143.31 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $6,400.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL SWEAT GLAND LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11450",
            " Charge Amount ": " $5,059.14 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $3,541.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL SWEAT GLAND LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11462",
            " Charge Amount ": " $7,003.81 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $4,902.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC TR-EXT MAL+MARG 1.1-2 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11602",
            " Charge Amount ": " $9,091.69 ",
            " Min Reimb ": " $309.84 ",
            " Max Reimb ": " $6,364.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC TR-EXT MAL+MARG 2.1-3 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11603",
            " Charge Amount ": " $6,856.18 ",
            " Min Reimb ": " $557.22 ",
            " Max Reimb ": " $4,799.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC TR-EXT MAL+MARG 3.1-4 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11604",
            " Charge Amount ": " $10,164.81 ",
            " Min Reimb ": " $557.22 ",
            " Max Reimb ": " $7,115.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC TR-EXT MAL+MARG >4 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11606",
            " Charge Amount ": " $10,522.94 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $7,366.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC S/N/H/F/G MAL+MRG 1.1-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11622",
            " Charge Amount ": " $6,072.67 ",
            " Min Reimb ": " $557.22 ",
            " Max Reimb ": " $4,250.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC S/N/H/F/G MAL+MRG 2.1-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11623",
            " Charge Amount ": " $8,051.77 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $5,636.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC S/N/H/F/G MAL+MRG 3.1-4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11624",
            " Charge Amount ": " $12,465.72 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $8,726.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC S/N/H/F/G MAL+MRG >4 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11626",
            " Charge Amount ": " $8,668.58 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $6,068.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC F/E/E/N/L MAL+MRG 0.6-1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11641",
            " Charge Amount ": " $9,581.06 ",
            " Min Reimb ": " $557.22 ",
            " Max Reimb ": " $6,706.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC F/E/E/N/L MAL+MRG 1.1-2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11642",
            " Charge Amount ": " $7,574.06 ",
            " Min Reimb ": " $557.22 ",
            " Max Reimb ": " $5,301.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC F/E/E/N/L MAL+MRG 2.1-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11643",
            " Charge Amount ": " $8,071.99 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $5,650.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC F/E/E/N/L MAL+MRG 3.1-4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11644",
            " Charge Amount ": " $8,787.72 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $6,151.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC F/E/E/N/L MAL+MRG >4 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11646",
            " Charge Amount ": " $9,356.60 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $6,549.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF NAIL PLATE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11730",
            " Charge Amount ": " $5,930.12 ",
            " Min Reimb ": " $78.70 ",
            " Max Reimb ": " $4,151.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF NAIL BED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11750",
            " Charge Amount ": " $6,146.06 ",
            " Min Reimb ": " $309.84 ",
            " Max Reimb ": " $4,302.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR OF NAIL BED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11760",
            " Charge Amount ": " $4,611.77 ",
            " Min Reimb ": " $78.70 ",
            " Max Reimb ": " $3,228.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE PILONIDAL CYST SIMPLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11770",
            " Charge Amount ": " $6,611.02 ",
            " Min Reimb ": " $1,384.44 ",
            " Max Reimb ": " $4,627.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE PILONIDAL CYST EXTEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11771",
            " Charge Amount ": " $6,456.24 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $4,519.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE PILONIDAL CYST COMPL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11772",
            " Charge Amount ": " $11,505.46 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $8,053.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INJECT SKIN LESIONS </W 7",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11900",
            " Charge Amount ": " $11,391.82 ",
            " Min Reimb ": " $160.86 ",
            " Max Reimb ": " $7,974.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CORRECT SKN COLOR 6.1-20.0CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11921",
            " Charge Amount ": " $7,610.12 ",
            " Min Reimb ": " $469.60 ",
            " Max Reimb ": " $5,327.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RPLCMT TISS XPNDR PERM IMPLT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11970",
            " Charge Amount ": " $19,677.04 ",
            " Min Reimb ": " $5,612.77 ",
            " Max Reimb ": " $13,773.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RMVL TIS XPNDR WO INSJ IMPLT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "11971",
            " Charge Amount ": " $10,190.18 ",
            " Min Reimb ": " $1,384.44 ",
            " Max Reimb ": " $7,133.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CMPLX RPR TRUNK 2.6-7.5 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "13101",
            " Charge Amount ": " $16,403.55 ",
            " Min Reimb ": " $469.60 ",
            " Max Reimb ": " $11,482.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CMPLX RPR E/N/E/L 1.1-2.5 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "13151",
            " Charge Amount ": " $4,599.56 ",
            " Min Reimb ": " $469.60 ",
            " Max Reimb ": " $3,219.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LATE CLOSURE OF WOUND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "13160",
            " Charge Amount ": " $8,065.44 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $5,645.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TIS TRNFR TRUNK 10 SQ CM/<",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "14000",
            " Charge Amount ": " $4,802.19 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $3,361.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TIS TRNFR S/A/L 10 SQ CM/<",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "14020",
            " Charge Amount ": " $9,389.89 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $6,572.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TIS TRNFR S/A/L 10.1-30 SQCM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "14021",
            " Charge Amount ": " $6,938.62 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $4,857.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TIS TRNFR F/C/C/M/N/A/G/H/F",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "14040",
            " Charge Amount ": " $6,619.80 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $4,633.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TIS TRNFR F/C/C/M/N/A/G/H/F",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "14041",
            " Charge Amount ": " $8,357.84 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $5,850.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TIS TRNFR E/N/E/L 10 SQ CM/<",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "14060",
            " Charge Amount ": " $6,893.70 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $4,825.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TIS TRNFR E/N/E/L10.1-30SQCM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "14061",
            " Charge Amount ": " $6,079.30 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $4,255.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TIS TRNFR ANY 30.1-60 SQ CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "14301",
            " Charge Amount ": " $9,598.63 ",
            " Min Reimb ": " $3,155.49 ",
            " Max Reimb ": " $6,719.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "WOUND PREP TRK/ARM/LEG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15002",
            " Charge Amount ": " $8,232.23 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $5,762.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SKIN SPLT GRFT TRNK/ARM/LEG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15100",
            " Charge Amount ": " $11,329.24 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $7,930.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SKIN FULL GRFT FACE/GENIT/HF",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15240",
            " Charge Amount ": " $10,987.84 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $7,691.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SKIN FULL GRAFT EEN & LIPS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15260",
            " Charge Amount ": " $6,743.61 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $4,720.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MUSCLE-SKIN GRAFT TRUNK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15734",
            " Charge Amount ": " $36,871.74 ",
            " Min Reimb ": " $3,155.49 ",
            " Max Reimb ": " $25,810.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISION OF LOWER EYELID",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15820",
            " Charge Amount ": " $9,270.05 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $6,489.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISION OF LOWER EYELID",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15821",
            " Charge Amount ": " $11,562.40 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $8,093.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISION OF UPPER EYELID",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15823",
            " Charge Amount ": " $9,503.35 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $6,652.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF NECK WRINKLES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15825",
            " Charge Amount ": " $28,051.71 ",
            " Min Reimb ": " $2,903.04 ",
            " Max Reimb ": " $19,636.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF FACE WRINKLES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15828",
            " Charge Amount ": " $32,280.29 ",
            " Min Reimb ": " $2,903.04 ",
            " Max Reimb ": " $22,596.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC SKIN ABD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15830",
            " Charge Amount ": " $30,693.66 ",
            " Min Reimb ": " $2,903.04 ",
            " Max Reimb ": " $21,485.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXCISE EXCESSIVE SKIN THIGH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15832",
            " Charge Amount ": " $20,034.76 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $14,024.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXCISE EXCESSIVE SKIN HIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15834",
            " Charge Amount ": " $47,415.82 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $33,191.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXCISE EXCESSIVE SKIN ARM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15836",
            " Charge Amount ": " $23,623.65 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $16,536.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SUCTION LIPECTOMY HEAD&NECK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15876",
            " Charge Amount ": " $14,049.10 ",
            " Min Reimb ": " $2,903.04 ",
            " Max Reimb ": " $9,834.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SUCTION LIPECTOMY TRUNK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15877",
            " Charge Amount ": " $12,458.68 ",
            " Min Reimb ": " $2,903.04 ",
            " Max Reimb ": " $8,721.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SUCTION LIPECTOMY LWR EXTREM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "15879",
            " Charge Amount ": " $13,569.49 ",
            " Min Reimb ": " $2,903.04 ",
            " Max Reimb ": " $9,498.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DESTRUCT B9 LESION 1-14",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "17110",
            " Charge Amount ": " $5,305.81 ",
            " Min Reimb ": " $160.86 ",
            " Max Reimb ": " $3,714.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DESTRUCT LESION 15 OR MORE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "17111",
            " Charge Amount ": " $5,329.12 ",
            " Min Reimb ": " $160.86 ",
            " Max Reimb ": " $3,730.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SKIN TISSUE PROCEDURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "17999",
            " Charge Amount ": " $6,124.62 ",
            " Min Reimb ": " $160.86 ",
            " Max Reimb ": " $4,287.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BIOPSY OF BREAST OPEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19101",
            " Charge Amount ": " $5,404.84 ",
            " Min Reimb ": " $991.88 ",
            " Max Reimb ": " $3,783.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NIPPLE EXPLORATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19110",
            " Charge Amount ": " $5,177.06 ",
            " Min Reimb ": " $991.88 ",
            " Max Reimb ": " $3,623.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF BREAST LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19120",
            " Charge Amount ": " $6,474.99 ",
            " Min Reimb ": " $991.88 ",
            " Max Reimb ": " $4,532.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXCISION BREAST LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19125",
            " Charge Amount ": " $14,131.86 ",
            " Min Reimb ": " $991.88 ",
            " Max Reimb ": " $9,892.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF BREAST TISSUE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19300",
            " Charge Amount ": " $20,575.65 ",
            " Min Reimb ": " $2,126.08 ",
            " Max Reimb ": " $14,402.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PARTIAL MASTECTOMY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19301",
            " Charge Amount ": " $12,771.27 ",
            " Min Reimb ": " $2,126.08 ",
            " Max Reimb ": " $8,939.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "P-MASTECTOMY W/LN REMOVAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19302",
            " Charge Amount ": " $21,057.10 ",
            " Min Reimb ": " $2,126.08 ",
            " Max Reimb ": " $14,739.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MAST SIMPLE COMPLETE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19303",
            " Charge Amount ": " $36,187.42 ",
            " Min Reimb ": " $2,126.08 ",
            " Max Reimb ": " $25,331.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MAST MOD RAD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19307",
            " Charge Amount ": " $20,302.24 ",
            " Min Reimb ": " $2,861.75 ",
            " Max Reimb ": " $14,211.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SUSPENSION OF BREAST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19316",
            " Charge Amount ": " $34,844.88 ",
            " Min Reimb ": " $2,126.08 ",
            " Max Reimb ": " $24,391.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BREAST REDUCTION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19318",
            " Charge Amount ": " $29,675.86 ",
            " Min Reimb ": " $2,861.75 ",
            " Max Reimb ": " $20,773.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BREAST AUGMENTATION W/IMPLT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19325",
            " Charge Amount ": " $19,097.99 ",
            " Min Reimb ": " $2,126.08 ",
            " Max Reimb ": " $13,368.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RMVL INTACT BREAST IMPLANT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19328",
            " Charge Amount ": " $7,276.58 ",
            " Min Reimb ": " $2,126.08 ",
            " Max Reimb ": " $5,093.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INSJ BREAST IMPLT SM D MAST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19340",
            " Charge Amount ": " $19,478.52 ",
            " Min Reimb ": " $2,126.08 ",
            " Max Reimb ": " $13,634.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INSJ/RPLCMT BRST IMPLT SEP D",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19342",
            " Charge Amount ": " $15,206.86 ",
            " Min Reimb ": " $2,126.08 ",
            " Max Reimb ": " $10,644.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TISS XPNDR PLMT BRST RCNSTJ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19357",
            " Charge Amount ": " $60,269.87 ",
            " Min Reimb ": " $2,861.75 ",
            " Max Reimb ": " $42,188.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVJ PERI-IMPLT CAPSULE BRST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19370",
            " Charge Amount ": " $8,306.18 ",
            " Min Reimb ": " $2,126.08 ",
            " Max Reimb ": " $5,814.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PERI-IMPLT CAPSLC BRST COMPL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19371",
            " Charge Amount ": " $22,050.58 ",
            " Min Reimb ": " $2,126.08 ",
            " Max Reimb ": " $15,435.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVJ RECONSTRUCTED BREAST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "19380",
            " Charge Amount ": " $24,591.58 ",
            " Min Reimb ": " $2,126.08 ",
            " Max Reimb ": " $17,214.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXPLORE WOUND EXTREMITY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20103",
            " Charge Amount ": " $5,593.52 ",
            " Min Reimb ": " $557.22 ",
            " Max Reimb ": " $3,915.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DEEP MUSCLE BIOPSY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20205",
            " Charge Amount ": " $4,925.47 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $3,447.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NEEDLE BIOPSY MUSCLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20206",
            " Charge Amount ": " $5,207.92 ",
            " Min Reimb ": " $545.86 ",
            " Max Reimb ": " $3,645.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BONE BIOPSY TROCAR/NEEDLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20220",
            " Charge Amount ": " $5,284.60 ",
            " Min Reimb ": " $545.86 ",
            " Max Reimb ": " $3,699.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BONE BIOPSY TROCAR/NEEDLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20225",
            " Charge Amount ": " $9,676.68 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $6,773.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BONE BIOPSY OPEN SUPERFICIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20240",
            " Charge Amount ": " $5,877.88 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $4,114.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF FOREIGN BODY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20520",
            " Charge Amount ": " $7,127.84 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $4,989.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF FOREIGN BODY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20525",
            " Charge Amount ": " $4,179.83 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $2,925.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "THER INJECTION CARP TUNNEL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20526",
            " Charge Amount ": " $677.71 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $474.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INJ TENDON SHEATH/LIGAMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20550",
            " Charge Amount ": " $960.77 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $672.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INJ TENDON ORIGIN/INSERTION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20551",
            " Charge Amount ": " $1,559.15 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $1,091.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INJ TRIGGER POINT 1/2 MUSCL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20552",
            " Charge Amount ": " $1,600.89 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $1,120.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INJECT TRIGGER POINTS 3/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20553",
            " Charge Amount ": " $961.08 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $672.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DRAIN/INJ JOINT/BURSA W/O US",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20600",
            " Charge Amount ": " $1,973.48 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $1,381.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DRAIN/INJ JOINT/BURSA W/US",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20604",
            " Charge Amount ": " $1,324.78 ",
            " Min Reimb ": " $233.98 ",
            " Max Reimb ": " $927.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DRAIN/INJ JOINT/BURSA W/O US",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20605",
            " Charge Amount ": " $1,285.98 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $900.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DRAIN/INJ JOINT/BURSA W/O US",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20610",
            " Charge Amount ": " $2,263.95 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $1,584.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DRAIN/INJ JOINT/BURSA W/US",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20611",
            " Charge Amount ": " $1,112.47 ",
            " Min Reimb ": " $233.98 ",
            " Max Reimb ": " $778.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF SUPPORT IMPLANT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20670",
            " Charge Amount ": " $7,463.25 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $5,224.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF SUPPORT IMPLANT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20680",
            " Charge Amount ": " $10,119.68 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $7,083.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF BONE FOR GRAFT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "20900",
            " Charge Amount ": " $25,350.61 ",
            " Min Reimb ": " $5,612.77 ",
            " Max Reimb ": " $17,745.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FACE LES SC <2 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21011",
            " Charge Amount ": " $5,837.97 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $4,086.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FACE LES SBQ 2 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21012",
            " Charge Amount ": " $5,166.83 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $3,616.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FACE TUM DEEP < 2 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21013",
            " Charge Amount ": " $4,348.72 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $3,044.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FACE TUM DEEP 2 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21014",
            " Charge Amount ": " $6,929.35 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $4,850.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXCISE MAX/ZYGOMA B9 TUMOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21030",
            " Charge Amount ": " $5,904.56 ",
            " Min Reimb ": " $4,556.59 ",
            " Max Reimb ": " $4,133.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE EXOSTOSIS MANDIBLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21031",
            " Charge Amount ": " $10,891.01 ",
            " Min Reimb ": " $2,451.53 ",
            " Max Reimb ": " $7,623.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISION OF EYELID",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21282",
            " Charge Amount ": " $11,886.76 ",
            " Min Reimb ": " $1,287.56 ",
            " Max Reimb ": " $8,320.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CRANIO/MAXILLOFACIAL SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21299",
            " Charge Amount ": " $7,320.74 ",
            " Min Reimb ": " $189.57 ",
            " Max Reimb ": " $5,124.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CLOSED TX NOSE FX W/O STABLJ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21315",
            " Charge Amount ": " $5,689.26 ",
            " Min Reimb ": " $1,211.96 ",
            " Max Reimb ": " $3,982.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CLOSED TX NOSE FX W/ STABLJ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21320",
            " Charge Amount ": " $5,618.98 ",
            " Min Reimb ": " $1,287.56 ",
            " Max Reimb ": " $3,933.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "OPEN TX NOSE FX UNCOMPLICATD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21325",
            " Charge Amount ": " $7,878.87 ",
            " Min Reimb ": " $2,451.53 ",
            " Max Reimb ": " $5,515.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC NECK LES SC 3 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21552",
            " Charge Amount ": " $6,445.02 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $4,511.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC NECK TUM DEEP 5 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21554",
            " Charge Amount ": " $6,306.45 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $4,414.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC NECK LES SC < 3 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21555",
            " Charge Amount ": " $12,716.96 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $8,901.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC NECK TUM DEEP < 5 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21556",
            " Charge Amount ": " $5,523.76 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $3,866.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RESECT NECK TUMOR 5 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21558",
            " Charge Amount ": " $11,856.05 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $8,299.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC BACK LES SC < 3 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21930",
            " Charge Amount ": " $7,305.59 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $5,113.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC BACK LES SC 3 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21931",
            " Charge Amount ": " $9,229.18 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $6,460.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC BACK TUM DEEP < 5 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21932",
            " Charge Amount ": " $5,617.63 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $3,932.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC BACK TUM DEEP 5 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "21933",
            " Charge Amount ": " $7,887.14 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $5,520.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE PART LUMBAR VERTEBRA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "22102",
            " Charge Amount ": " $18,267.17 ",
            " Min Reimb ": " $2,684.15 ",
            " Max Reimb ": " $12,787.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PERQ VERTEBRAL AUGMENTATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "22513",
            " Charge Amount ": " $24,070.50 ",
            " Min Reimb ": " $2,684.15 ",
            " Max Reimb ": " $16,849.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PERQ VERTEBRAL AUGMENTATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "22514",
            " Charge Amount ": " $22,561.49 ",
            " Min Reimb ": " $2,684.15 ",
            " Max Reimb ": " $15,793.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NECK SPINE FUSE&REMOV BEL C2",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "22551",
            " Charge Amount ": " $51,028.12 ",
            " Min Reimb ": " $4,733.76 ",
            " Max Reimb ": " $35,719.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NECK SPINE FUSION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "22554",
            " Charge Amount ": " $78,334.50 ",
            " Min Reimb ": " $4,733.76 ",
            " Max Reimb ": " $54,834.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NECK SPINE FUSION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "22600",
            " Charge Amount ": " $22,296.67 ",
            " Min Reimb ": " $4,733.76 ",
            " Max Reimb ": " $15,607.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LUMBAR SPINE FUSION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "22612",
            " Charge Amount ": " $142,971.49 ",
            " Min Reimb ": " $4,733.76 ",
            " Max Reimb ": " $100,080.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LUMBAR SPINE FUSION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "22630",
            " Charge Amount ": " $26,130.49 ",
            " Min Reimb ": " $4,733.76 ",
            " Max Reimb ": " $18,291.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LUMBAR SPINE FUSION COMBINED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "22633",
            " Charge Amount ": " $109,200.73 ",
            " Min Reimb ": " $4,733.76 ",
            " Max Reimb ": " $76,440.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CERV ARTIFIC DISKECTOMY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "22856",
            " Charge Amount ": " $49,014.04 ",
            " Min Reimb ": " $4,733.76 ",
            " Max Reimb ": " $34,309.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC ABDL TUM DEEP < 5 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "22900",
            " Charge Amount ": " $4,774.48 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $3,342.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC ABDL TUM DEEP 5 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "22901",
            " Charge Amount ": " $4,520.43 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $3,164.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC ABD LES SC < 3 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "22902",
            " Charge Amount ": " $7,470.06 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $5,229.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC ABD LES SC 3 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "22903",
            " Charge Amount ": " $9,155.16 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $6,408.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC SHOULDER LES SC 3 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "23071",
            " Charge Amount ": " $7,204.36 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $5,043.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC SHOULDER TUM DEEP 5 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "23073",
            " Charge Amount ": " $8,425.00 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $5,897.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC SHOULDER TUM DEEP < 5 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "23076",
            " Charge Amount ": " $5,254.02 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $3,677.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PARTIAL REMOVAL COLLAR BONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "23120",
            " Charge Amount ": " $16,232.07 ",
            " Min Reimb ": " $2,125.70 ",
            " Max Reimb ": " $11,362.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR ROTATOR CUFF ACUTE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "23410",
            " Charge Amount ": " $23,422.26 ",
            " Min Reimb ": " $2,125.70 ",
            " Max Reimb ": " $16,395.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR ROTATOR CUFF CHRONIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "23412",
            " Charge Amount ": " $16,799.42 ",
            " Min Reimb ": " $2,125.70 ",
            " Max Reimb ": " $11,759.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR BICEPS TENDON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "23430",
            " Charge Amount ": " $33,587.64 ",
            " Min Reimb ": " $2,125.70 ",
            " Max Reimb ": " $23,511.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR SHOULDER CAPSULE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "23466",
            " Charge Amount ": " $21,635.31 ",
            " Min Reimb ": " $2,125.70 ",
            " Max Reimb ": " $15,144.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RECONSTRUCT SHOULDER JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "23470",
            " Charge Amount ": " $42,287.43 ",
            " Min Reimb ": " $2,868.83 ",
            " Max Reimb ": " $29,601.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVIS RECONST SHOULDER JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "23473",
            " Charge Amount ": " $28,705.65 ",
            " Min Reimb ": " $2,868.83 ",
            " Max Reimb ": " $20,093.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT SHOULDER DISLOCATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "23655",
            " Charge Amount ": " $8,898.58 ",
            " Min Reimb ": " $727.41 ",
            " Max Reimb ": " $6,229.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "FIXATION OF SHOULDER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "23700",
            " Charge Amount ": " $5,930.42 ",
            " Min Reimb ": " $727.41 ",
            " Max Reimb ": " $4,151.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC ARM/ELBOW LES SC 3 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "24071",
            " Charge Amount ": " $7,061.31 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $4,942.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC ARM/ELBOW LES SC < 3 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "24075",
            " Charge Amount ": " $11,455.14 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $8,018.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EX ARM/ELBOW TUM DEEP < 5 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "24076",
            " Charge Amount ": " $7,636.93 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $5,345.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF ELBOW BURSA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "24105",
            " Charge Amount ": " $9,009.40 ",
            " Min Reimb ": " $1,245.31 ",
            " Max Reimb ": " $6,306.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR ARM TENDON/MUSCLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "24341",
            " Charge Amount ": " $13,973.05 ",
            " Min Reimb ": " $2,125.70 ",
            " Max Reimb ": " $9,781.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR OF RUPTURED TENDON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "24342",
            " Charge Amount ": " $19,018.44 ",
            " Min Reimb ": " $2,125.70 ",
            " Max Reimb ": " $13,312.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR ELBOW W/DEB OPEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "24358",
            " Charge Amount ": " $10,255.86 ",
            " Min Reimb ": " $1,245.31 ",
            " Max Reimb ": " $7,179.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR ELBOW DEB/ATTCH OPEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "24359",
            " Charge Amount ": " $9,111.27 ",
            " Min Reimb ": " $1,245.31 ",
            " Max Reimb ": " $6,377.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT HUMERUS FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "24515",
            " Charge Amount ": " $28,804.86 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $20,163.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT HUMERUS FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "24545",
            " Charge Amount ": " $49,410.06 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $34,587.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT RADIUS FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "24665",
            " Charge Amount ": " $21,038.91 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $14,727.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT ULNAR FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "24685",
            " Charge Amount ": " $30,032.65 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $21,022.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INCISION OF TENDON SHEATH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25000",
            " Charge Amount ": " $6,000.40 ",
            " Min Reimb ": " $1,245.31 ",
            " Max Reimb ": " $4,200.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FOREARM LES SC 3 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25071",
            " Charge Amount ": " $8,993.86 ",
            " Min Reimb ": " $1,245.31 ",
            " Max Reimb ": " $6,295.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FOREARM TUM DEEP 3 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25073",
            " Charge Amount ": " $8,271.57 ",
            " Min Reimb ": " $1,245.31 ",
            " Max Reimb ": " $5,790.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FOREARM LES SC < 3 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25075",
            " Charge Amount ": " $5,030.70 ",
            " Min Reimb ": " $1,245.31 ",
            " Max Reimb ": " $3,521.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FOREARM TUM DEEP < 3 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25076",
            " Charge Amount ": " $7,166.21 ",
            " Min Reimb ": " $1,245.31 ",
            " Max Reimb ": " $5,016.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE WRIST JOINT LINING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25105",
            " Charge Amount ": " $12,152.26 ",
            " Min Reimb ": " $1,245.31 ",
            " Max Reimb ": " $8,506.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE WRIST TENDON LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25111",
            " Charge Amount ": " $6,327.09 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $4,428.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REREMOVE WRIST TENDON LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25112",
            " Charge Amount ": " $5,748.20 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $4,023.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE WRIST/FOREARM LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25115",
            " Charge Amount ": " $5,851.10 ",
            " Min Reimb ": " $1,245.31 ",
            " Max Reimb ": " $4,096.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF WRIST LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25130",
            " Charge Amount ": " $8,678.69 ",
            " Min Reimb ": " $1,245.31 ",
            " Max Reimb ": " $6,075.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PARTIAL REMOVAL OF ULNA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25240",
            " Charge Amount ": " $10,567.80 ",
            " Min Reimb ": " $1,245.31 ",
            " Max Reimb ": " $7,397.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR/REVISE WRIST JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25320",
            " Charge Amount ": " $31,795.24 ",
            " Min Reimb ": " $2,259.37 ",
            " Max Reimb ": " $22,256.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE WRIST JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25332",
            " Charge Amount ": " $25,901.81 ",
            " Min Reimb ": " $1,547.38 ",
            " Max Reimb ": " $18,131.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RECONSTRUCT WRIST JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25441",
            " Charge Amount ": " $41,123.07 ",
            " Min Reimb ": " $2,868.83 ",
            " Max Reimb ": " $28,786.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR WRIST JOINTS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25447",
            " Charge Amount ": " $17,789.54 ",
            " Min Reimb ": " $1,547.38 ",
            " Max Reimb ": " $12,452.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT FRACTURE RADIUS/ULNA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25605",
            " Charge Amount ": " $5,747.66 ",
            " Min Reimb ": " $324.03 ",
            " Max Reimb ": " $4,023.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT FX DISTAL RADIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25606",
            " Charge Amount ": " $6,013.16 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $4,209.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT FX RAD EXTRA-ARTICUL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25607",
            " Charge Amount ": " $33,314.50 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $23,320.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT FX RAD INTRA-ARTICUL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25608",
            " Charge Amount ": " $23,060.99 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $16,142.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT FX RADIAL 3+ FRAG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25609",
            " Charge Amount ": " $27,596.21 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $19,317.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT WRIST BONE FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25628",
            " Charge Amount ": " $23,444.75 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $16,411.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "FUSION OF HAND BONES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "25820",
            " Charge Amount ": " $41,635.39 ",
            " Min Reimb ": " $1,645.95 ",
            " Max Reimb ": " $29,144.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INCISE FINGER TENDON SHEATH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26055",
            " Charge Amount ": " $6,484.14 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $4,538.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC HAND LES SC 1.5 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26111",
            " Charge Amount ": " $7,565.54 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $5,295.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC HAND TUM DEEP 1.5 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26113",
            " Charge Amount ": " $5,791.29 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $4,053.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC HAND LES SC < 1.5 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26115",
            " Charge Amount ": " $5,210.08 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $3,647.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC HAND TUM DEEP < 1.5 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26116",
            " Charge Amount ": " $8,485.44 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $5,939.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RELEASE PALM CONTRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26121",
            " Charge Amount ": " $11,901.86 ",
            " Min Reimb ": " $1,645.95 ",
            " Max Reimb ": " $8,331.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RELEASE PALM CONTRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26123",
            " Charge Amount ": " $10,608.00 ",
            " Min Reimb ": " $1,645.95 ",
            " Max Reimb ": " $7,425.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE WRIST JOINT LINING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26130",
            " Charge Amount ": " $6,996.22 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $4,897.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE FINGER JOINT EACH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26140",
            " Charge Amount ": " $8,095.45 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $5,666.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TENDON EXCISION PALM/FINGER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26145",
            " Charge Amount ": " $7,049.12 ",
            " Min Reimb ": " $1,247.41 ",
            " Max Reimb ": " $4,934.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE TENDON SHEATH LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26160",
            " Charge Amount ": " $6,411.43 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $4,487.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF FINGER TENDON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26180",
            " Charge Amount ": " $5,182.32 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $3,627.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE FINGER BONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26185",
            " Charge Amount ": " $9,889.85 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $6,922.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF FINGER LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26210",
            " Charge Amount ": " $7,910.97 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $5,537.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PARTIAL REMOVAL FINGER BONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26236",
            " Charge Amount ": " $11,158.13 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $7,810.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR FINGER/HAND TENDON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26356",
            " Charge Amount ": " $8,485.38 ",
            " Min Reimb ": " $1,645.95 ",
            " Max Reimb ": " $5,939.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR FINGER TENDON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26433",
            " Charge Amount ": " $21,451.05 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $15,015.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR/GRAFT FINGER TENDON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26434",
            " Charge Amount ": " $13,796.06 ",
            " Min Reimb ": " $1,645.95 ",
            " Max Reimb ": " $9,657.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REALIGNMENT OF TENDONS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26437",
            " Charge Amount ": " $5,847.91 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $4,093.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RELEASE PALM/FINGER TENDON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26440",
            " Charge Amount ": " $6,327.82 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $4,429.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "FUSION OF FINGER TENDONS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26471",
            " Charge Amount ": " $10,843.93 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $7,590.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE/IMPLANT FINGER JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26536",
            " Charge Amount ": " $25,816.69 ",
            " Min Reimb ": " $1,547.38 ",
            " Max Reimb ": " $18,071.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR HAND JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26540",
            " Charge Amount ": " $21,282.58 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $14,897.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR NONUNION HAND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26546",
            " Charge Amount ": " $9,829.27 ",
            " Min Reimb ": " $1,645.95 ",
            " Max Reimb ": " $6,880.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT METACARPAL FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26608",
            " Charge Amount ": " $6,248.66 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $4,374.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT METACARPAL FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26615",
            " Charge Amount ": " $21,190.52 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $14,833.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT FINGER FRACTURE EACH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26727",
            " Charge Amount ": " $6,890.36 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $4,823.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT FINGER FRACTURE EACH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26735",
            " Charge Amount ": " $19,422.30 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $13,595.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT FINGER FRACTURE EACH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26765",
            " Charge Amount ": " $11,948.61 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $8,364.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "FUSION/GRAFT OF FINGER JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "26862",
            " Charge Amount ": " $16,219.99 ",
            " Min Reimb ": " $1,099.23 ",
            " Max Reimb ": " $11,353.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC HIP PELVIS LES SC 3 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27043",
            " Charge Amount ": " $7,224.09 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $5,056.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC HIP/PELV TUM DEEP 5 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27045",
            " Charge Amount ": " $5,059.91 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $3,541.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE FEMUR LESION/BURSA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27062",
            " Charge Amount ": " $25,180.84 ",
            " Min Reimb ": " $2,079.48 ",
            " Max Reimb ": " $17,626.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE HIP BONE LES SUPER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27065",
            " Charge Amount ": " $17,551.60 ",
            " Min Reimb ": " $2,079.48 ",
            " Max Reimb ": " $12,286.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INJECT SACROILIAC JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27096",
            " Charge Amount ": " $4,340.36 ",
            " Min Reimb ": " $426.37 ",
            " Max Reimb ": " $3,038.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TOTAL HIP ARTHROPLASTY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27130",
            " Charge Amount ": " $44,596.42 ",
            " Min Reimb ": " $2,868.83 ",
            " Max Reimb ": " $31,217.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT HIP DISLOCATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27266",
            " Charge Amount ": " $11,084.75 ",
            " Min Reimb ": " $727.41 ",
            " Max Reimb ": " $7,759.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PELVIS/HIP JOINT SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27299",
            " Charge Amount ": " $5,185.17 ",
            " Min Reimb ": " $184.73 ",
            " Max Reimb ": " $3,629.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC THIGH/KNEE LES SC < 3 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27327",
            " Charge Amount ": " $10,793.39 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $7,555.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC THIGH/KNEE TUM DEEP <5CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27328",
            " Charge Amount ": " $5,184.67 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $3,629.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC THIGH/KNEE LES SC 3 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27337",
            " Charge Amount ": " $15,323.13 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $10,726.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC THIGH/KNEE TUM DEP 5CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27339",
            " Charge Amount ": " $7,805.48 ",
            " Min Reimb ": " $2,123.29 ",
            " Max Reimb ": " $5,463.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF KNEECAP BURSA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27340",
            " Charge Amount ": " $10,161.76 ",
            " Min Reimb ": " $1,847.70 ",
            " Max Reimb ": " $7,113.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE KNEE CYST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27347",
            " Charge Amount ": " $10,056.58 ",
            " Min Reimb ": " $1,847.70 ",
            " Max Reimb ": " $7,039.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR OF KNEECAP TENDON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27380",
            " Charge Amount ": " $18,436.96 ",
            " Min Reimb ": " $1,847.70 ",
            " Max Reimb ": " $12,905.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR OF THIGH MUSCLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27385",
            " Charge Amount ": " $21,380.86 ",
            " Min Reimb ": " $2,079.48 ",
            " Max Reimb ": " $14,966.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "OSTEOCHONDRAL KNEE ALLOGRAFT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27415",
            " Charge Amount ": " $27,712.86 ",
            " Min Reimb ": " $2,155.78 ",
            " Max Reimb ": " $19,399.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RECONSTRUCTION KNEE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27427",
            " Charge Amount ": " $36,331.18 ",
            " Min Reimb ": " $2,320.27 ",
            " Max Reimb ": " $25,431.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RECONSTRUCTION KNEE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27428",
            " Charge Amount ": " $48,385.03 ",
            " Min Reimb ": " $2,320.27 ",
            " Max Reimb ": " $33,869.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISION OF KNEE JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27446",
            " Charge Amount ": " $41,542.15 ",
            " Min Reimb ": " $2,868.83 ",
            " Max Reimb ": " $29,079.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TOTAL KNEE ARTHROPLASTY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27447",
            " Charge Amount ": " $48,441.97 ",
            " Min Reimb ": " $2,868.83 ",
            " Max Reimb ": " $33,909.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT KNEECAP FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27524",
            " Charge Amount ": " $27,076.15 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $18,953.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "FIXATION OF KNEE JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27570",
            " Charge Amount ": " $4,929.89 ",
            " Min Reimb ": " $727.41 ",
            " Max Reimb ": " $3,450.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LEG SURGERY PROCEDURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27599",
            " Charge Amount ": " $12,481.72 ",
            " Min Reimb ": " $184.73 ",
            " Max Reimb ": " $8,737.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DECOMPRESSION OF LOWER LEG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27600",
            " Charge Amount ": " $15,633.96 ",
            " Min Reimb ": " $1,847.70 ",
            " Max Reimb ": " $10,943.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DECOMPRESSION OF LOWER LEG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27602",
            " Charge Amount ": " $12,380.74 ",
            " Min Reimb ": " $1,847.70 ",
            " Max Reimb ": " $8,666.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC LEG/ANKLE TUM < 3 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27618",
            " Charge Amount ": " $6,960.63 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $4,872.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC LEG/ANKLE LES SC 3 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27632",
            " Charge Amount ": " $11,529.28 ",
            " Min Reimb ": " $1,847.70 ",
            " Max Reimb ": " $8,070.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC LEG/ANKLE TUM DEP 5 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27634",
            " Charge Amount ": " $9,733.19 ",
            " Min Reimb ": " $1,847.70 ",
            " Max Reimb ": " $6,813.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE LOWER LEG BONE LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27635",
            " Charge Amount ": " $7,563.06 ",
            " Min Reimb ": " $1,847.70 ",
            " Max Reimb ": " $5,294.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR ACHILLES TENDON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27650",
            " Charge Amount ": " $15,835.27 ",
            " Min Reimb ": " $1,847.70 ",
            " Max Reimb ": " $11,084.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR OF ACHILLES TENDON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27654",
            " Charge Amount ": " $17,182.61 ",
            " Min Reimb ": " $2,320.27 ",
            " Max Reimb ": " $12,027.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR OF LEG TENDON EACH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27658",
            " Charge Amount ": " $6,550.94 ",
            " Min Reimb ": " $1,847.70 ",
            " Max Reimb ": " $4,585.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE LOWER LEG TENDON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27691",
            " Charge Amount ": " $20,669.89 ",
            " Min Reimb ": " $2,320.27 ",
            " Max Reimb ": " $14,468.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR OF ANKLE LIGAMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27698",
            " Charge Amount ": " $21,879.38 ",
            " Min Reimb ": " $2,320.27 ",
            " Max Reimb ": " $15,315.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISION OF ANKLE JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27700",
            " Charge Amount ": " $15,981.28 ",
            " Min Reimb ": " $1,547.38 ",
            " Max Reimb ": " $11,186.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR FIBULA NONUNION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27726",
            " Charge Amount ": " $31,307.25 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $21,915.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "OPTX MEDIAL ANKLE FX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27766",
            " Charge Amount ": " $19,566.70 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $13,696.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREATMENT OF ANKLE FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27792",
            " Charge Amount ": " $29,355.86 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $20,549.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREATMENT OF ANKLE FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27814",
            " Charge Amount ": " $28,740.89 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $20,118.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREATMENT OF ANKLE FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27822",
            " Charge Amount ": " $25,665.01 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $17,965.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT LOWER LEG FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27827",
            " Charge Amount ": " $37,056.09 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $25,939.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "FUSION OF ANKLE JOINT OPEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "27870",
            " Charge Amount ": " $52,859.94 ",
            " Min Reimb ": " $2,320.27 ",
            " Max Reimb ": " $37,001.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT FOOT BONE LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28005",
            " Charge Amount ": " $6,693.16 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $4,685.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INCISION OF FOOT FASCIA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28008",
            " Charge Amount ": " $5,994.28 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $4,195.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DECOMPRESSION OF TIBIA NERVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28035",
            " Charge Amount ": " $9,764.48 ",
            " Min Reimb ": " $1,571.76 ",
            " Max Reimb ": " $6,835.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FOOT/TOE TUM SC 1.5 CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28039",
            " Charge Amount ": " $7,985.25 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $5,589.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FOOT/TOE TUM DEP 1.5CM/>",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28041",
            " Charge Amount ": " $5,531.75 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $3,872.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FOOT/TOE TUM SC < 1.5 CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28043",
            " Charge Amount ": " $5,947.96 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $4,163.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC FOOT/TOE TUM DEEP <1.5CM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28045",
            " Charge Amount ": " $9,433.68 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $6,603.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PARTIAL REMOVAL FOOT FASCIA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28060",
            " Charge Amount ": " $8,112.54 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $5,678.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF FOOT LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28090",
            " Charge Amount ": " $6,274.90 ",
            " Min Reimb ": " $1,247.41 ",
            " Max Reimb ": " $4,392.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF TOE LESIONS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28092",
            " Charge Amount ": " $9,786.45 ",
            " Min Reimb ": " $1,247.41 ",
            " Max Reimb ": " $6,850.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF ANKLE/HEEL LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28100",
            " Charge Amount ": " $7,256.09 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $5,079.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF FOOT LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28104",
            " Charge Amount ": " $7,207.54 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $5,045.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF TOE LESIONS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28108",
            " Charge Amount ": " $6,205.93 ",
            " Min Reimb ": " $1,247.41 ",
            " Max Reimb ": " $4,344.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PART REMOVAL OF METATARSAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28112",
            " Charge Amount ": " $23,797.30 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $16,658.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF HEEL BONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28118",
            " Charge Amount ": " $12,994.72 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $9,096.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PARTIAL REMOVAL OF FOOT BONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28122",
            " Charge Amount ": " $8,132.61 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $5,692.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PARTIAL REMOVAL OF TOE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28124",
            " Charge Amount ": " $7,454.81 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $5,218.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF TOE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28150",
            " Charge Amount ": " $6,724.07 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $4,706.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR OF FOOT TENDON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28200",
            " Charge Amount ": " $16,368.26 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $11,457.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR OF FOOT TENDON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28208",
            " Charge Amount ": " $31,165.43 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $21,815.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISION OF FOOT TENDON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28238",
            " Charge Amount ": " $24,389.94 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $17,072.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RELEASE OF FOOT CONTRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28270",
            " Charge Amount ": " $10,384.64 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $7,269.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR OF HAMMERTOE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28285",
            " Charge Amount ": " $13,539.80 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $9,477.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PARTIAL REMOVAL OF FOOT BONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28288",
            " Charge Amount ": " $5,563.96 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $3,894.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CORRJ HALUX RIGDUS W/O IMPLT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28289",
            " Charge Amount ": " $7,849.19 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $5,494.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CORRJ HALUX RIGDUS W/IMPLT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28291",
            " Charge Amount ": " $15,203.94 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $10,642.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CORRECTION HALLUX VALGUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28292",
            " Charge Amount ": " $7,077.01 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $4,953.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CORRECTION HALLUX VALGUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28296",
            " Charge Amount ": " $8,763.96 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $6,134.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CORRECTION HALLUX VALGUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28297",
            " Charge Amount ": " $29,601.33 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $20,720.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CORRECTION HALLUX VALGUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28298",
            " Charge Amount ": " $10,121.16 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $7,084.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INCISION OF HEEL BONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28300",
            " Charge Amount ": " $26,893.80 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $18,825.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INCISION OF METATARSAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28308",
            " Charge Amount ": " $6,613.37 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $4,629.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT ANKLE FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28445",
            " Charge Amount ": " $41,815.02 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $29,270.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT METATARSAL FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28476",
            " Charge Amount ": " $19,052.91 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $13,337.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT METATARSAL FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28485",
            " Charge Amount ": " $22,130.38 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $15,491.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT TOE FRACTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28525",
            " Charge Amount ": " $7,268.55 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $5,087.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR TOE DISLOCATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28645",
            " Charge Amount ": " $15,938.99 ",
            " Min Reimb ": " $2,161.58 ",
            " Max Reimb ": " $11,157.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "FUSION OF FOOT BONES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28715",
            " Charge Amount ": " $37,430.44 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $26,201.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "FUSION OF FOOT BONES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28725",
            " Charge Amount ": " $36,555.62 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $25,588.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "FUSION OF FOOT BONES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28730",
            " Charge Amount ": " $38,924.93 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $27,247.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "FUSION OF FOOT BONES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28740",
            " Charge Amount ": " $44,100.21 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $30,870.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "FUSION OF BIG TOE JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28750",
            " Charge Amount ": " $27,186.55 ",
            " Min Reimb ": " $2,118.98 ",
            " Max Reimb ": " $19,030.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "AMPUTATION OF TOE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28820",
            " Charge Amount ": " $7,840.18 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $5,488.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PARTIAL AMPUTATION OF TOE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "28825",
            " Charge Amount ": " $6,134.94 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $4,294.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "APPLICATION OF LONG ARM CAST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29065",
            " Charge Amount ": " $758.25 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $530.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "APPLICATION OF FOREARM CAST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29075",
            " Charge Amount ": " $900.78 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $630.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "APPLY LONG ARM SPLINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29105",
            " Charge Amount ": " $826.27 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $578.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "APPLY FOREARM SPLINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29125",
            " Charge Amount ": " $876.92 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $613.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "APPLICATION OF FINGER SPLINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29130",
            " Charge Amount ": " $1,137.38 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $796.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "APPLY SHORT LEG CAST",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29425",
            " Charge Amount ": " $970.96 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $679.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "APPLICATION LOWER LEG SPLINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29515",
            " Charge Amount ": " $791.82 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $554.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SHO ARTHRS SRG CAPSULORPAPHY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29806",
            " Charge Amount ": " $37,737.46 ",
            " Min Reimb ": " $2,155.78 ",
            " Max Reimb ": " $26,416.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SHO ARTHRS SRG RPR SLAP LES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29807",
            " Charge Amount ": " $33,429.77 ",
            " Min Reimb ": " $2,155.78 ",
            " Max Reimb ": " $23,400.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SHO ARTHRS SRG RMVL LOOSE/FB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29819",
            " Charge Amount ": " $24,570.97 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $17,199.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SHO ARTHRS SRG PRTL SYNVCT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29820",
            " Charge Amount ": " $12,967.93 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $9,077.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SHO ARTHRS SRG LMTD DBRDMT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29822",
            " Charge Amount ": " $14,016.51 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $9,811.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SHO ARTHRS SRG XTNSV DBRDMT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29823",
            " Charge Amount ": " $13,601.54 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $9,521.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SHO ARTHRS SRG DSTL CLAVICLC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29824",
            " Charge Amount ": " $18,516.59 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $12,961.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SHO ARTHRS SRG LSS&RESCJ ADS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29825",
            " Charge Amount ": " $21,191.73 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $14,834.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SHO ARTHRS SRG RT8TR CUF RPR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29827",
            " Charge Amount ": " $40,037.96 ",
            " Min Reimb ": " $2,155.78 ",
            " Max Reimb ": " $28,026.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SHO ARTHRS SRG BICP TENODSIS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29828",
            " Charge Amount ": " $31,037.81 ",
            " Min Reimb ": " $2,155.78 ",
            " Max Reimb ": " $21,726.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ELBOW ARTHROSCOPY/SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29837",
            " Charge Amount ": " $10,736.37 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $7,515.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "HIP ARTHR0 W/DEBRIDEMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29862",
            " Charge Amount ": " $24,678.55 ",
            " Min Reimb ": " $2,155.78 ",
            " Max Reimb ": " $17,274.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "HIP ARTHR0 W/SYNOVECTOMY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29863",
            " Charge Amount ": " $23,246.03 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $16,272.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "KNEE ARTHROSCOPY/SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29873",
            " Charge Amount ": " $15,549.60 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $10,884.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "KNEE ARTHROSCOPY/SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29875",
            " Charge Amount ": " $11,555.79 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $8,089.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "KNEE ARTHROSCOPY/SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29877",
            " Charge Amount ": " $14,738.00 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $10,316.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "KNEE ARTHROSCOPY/SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29879",
            " Charge Amount ": " $12,126.77 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $8,488.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "KNEE ARTHROSCOPY/SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29880",
            " Charge Amount ": " $10,291.41 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $7,203.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "KNEE ARTHROSCOPY/SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29881",
            " Charge Amount ": " $10,911.05 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $7,637.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "KNEE ARTHROSCOPY/SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29882",
            " Charge Amount ": " $25,024.30 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $17,517.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "KNEE ARTHROSCOPY/SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29884",
            " Charge Amount ": " $12,640.49 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $8,848.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "KNEE ARTHROSCOPY/SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29888",
            " Charge Amount ": " $40,013.08 ",
            " Min Reimb ": " $2,155.78 ",
            " Max Reimb ": " $28,009.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ANKLE ARTHROSCOPY/SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29892",
            " Charge Amount ": " $23,679.37 ",
            " Min Reimb ": " $2,155.78 ",
            " Max Reimb ": " $16,575.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SCOPE PLANTAR FASCIOTOMY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29893",
            " Charge Amount ": " $8,011.58 ",
            " Min Reimb ": " $1,522.55 ",
            " Max Reimb ": " $5,608.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ANKLE ARTHROSCOPY/SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29895",
            " Charge Amount ": " $17,177.95 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $12,024.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ANKLE ARTHROSCOPY/SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29898",
            " Charge Amount ": " $8,889.04 ",
            " Min Reimb ": " $1,620.73 ",
            " Max Reimb ": " $6,222.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "HIP ARTHRO W/LABRAL REPAIR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29916",
            " Charge Amount ": " $26,969.53 ",
            " Min Reimb ": " $2,155.78 ",
            " Max Reimb ": " $18,878.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ARTHROSCOPY OF JOINT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "29999",
            " Charge Amount ": " $19,391.11 ",
            " Min Reimb ": " $184.73 ",
            " Max Reimb ": " $13,573.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DRAINAGE OF NOSE LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "30000",
            " Charge Amount ": " $7,207.23 ",
            " Min Reimb ": " $166.12 ",
            " Max Reimb ": " $5,045.06 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF INTRANASAL LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "30117",
            " Charge Amount ": " $5,375.85 ",
            " Min Reimb ": " $1,113.49 ",
            " Max Reimb ": " $3,763.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PARTIAL REMOVAL OF NOSE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "30150",
            " Charge Amount ": " $12,781.75 ",
            " Min Reimb ": " $1,950.20 ",
            " Max Reimb ": " $8,947.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INSERT NASAL SEPTAL BUTTON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "30220",
            " Charge Amount ": " $7,941.56 ",
            " Min Reimb ": " $1,211.96 ",
            " Max Reimb ": " $5,559.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RECONSTRUCTION OF NOSE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "30410",
            " Charge Amount ": " $15,273.70 ",
            " Min Reimb ": " $1,950.20 ",
            " Max Reimb ": " $10,691.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR NASAL STENOSIS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "30465",
            " Charge Amount ": " $9,393.40 ",
            " Min Reimb ": " $1,950.20 ",
            " Max Reimb ": " $6,575.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR OF NASAL SEPTUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "30520",
            " Charge Amount ": " $8,651.08 ",
            " Min Reimb ": " $1,113.49 ",
            " Max Reimb ": " $6,055.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ABLATE INF TURBINATE SUBMUC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "30802",
            " Charge Amount ": " $16,671.80 ",
            " Min Reimb ": " $1,211.96 ",
            " Max Reimb ": " $11,670.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CONTROL OF NOSEBLEED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "30901",
            " Charge Amount ": " $5,034.25 ",
            " Min Reimb ": " $100.30 ",
            " Max Reimb ": " $3,523.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CONTROL OF NOSEBLEED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "30903",
            " Charge Amount ": " $5,632.95 ",
            " Min Reimb ": " $100.30 ",
            " Max Reimb ": " $3,943.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NASAL SURGERY PROCEDURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "30999",
            " Charge Amount ": " $4,424.58 ",
            " Min Reimb ": " $189.57 ",
            " Max Reimb ": " $3,097.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NASAL/SINUS ENDOSCOPY SURG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "31237",
            " Charge Amount ": " $9,550.05 ",
            " Min Reimb ": " $1,340.62 ",
            " Max Reimb ": " $6,685.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NASAL/SINUS ENDOSCOPY SURG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "31238",
            " Charge Amount ": " $6,488.79 ",
            " Min Reimb ": " $1,340.62 ",
            " Max Reimb ": " $4,542.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NSL/SINS NDSC W/TOT ETHMDCT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "31255",
            " Charge Amount ": " $12,480.25 ",
            " Min Reimb ": " $1,561.89 ",
            " Max Reimb ": " $8,736.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DX LARYNGOSCOPY EXCL NB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "31525",
            " Charge Amount ": " $6,646.08 ",
            " Min Reimb ": " $355.38 ",
            " Max Reimb ": " $4,652.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LARYNGOSCOPY W/BIOPSY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "31535",
            " Charge Amount ": " $9,275.20 ",
            " Min Reimb ": " $1,561.89 ",
            " Max Reimb ": " $6,492.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LARYNSCOP W/TUMR EXC + SCOPE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "31541",
            " Charge Amount ": " $6,328.95 ",
            " Min Reimb ": " $1,561.89 ",
            " Max Reimb ": " $4,430.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ASPIRATE PLEURA W/ IMAGING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "32555",
            " Charge Amount ": " $4,552.75 ",
            " Min Reimb ": " $485.24 ",
            " Max Reimb ": " $3,186.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ROUTINE VENIPUNCTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "36415",
            " Charge Amount ": " $312.64 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $218.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INSERT TUNNELED CV CATH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "36561",
            " Charge Amount ": " $9,456.31 ",
            " Min Reimb ": " $1,110.69 ",
            " Max Reimb ": " $6,619.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INSERT TUNNELED CV CATH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "36563",
            " Charge Amount ": " $15,958.57 ",
            " Min Reimb ": " $1,110.69 ",
            " Max Reimb ": " $11,170.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INSJ PICC 5 YR+ W/O IMAGING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "36569",
            " Charge Amount ": " $5,835.99 ",
            " Min Reimb ": " $526.06 ",
            " Max Reimb ": " $4,085.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INSERT PICVAD CATH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "36571",
            " Charge Amount ": " $13,569.06 ",
            " Min Reimb ": " $526.06 ",
            " Max Reimb ": " $9,498.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPLACE TUNNELED CV CATH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "36582",
            " Charge Amount ": " $9,925.32 ",
            " Min Reimb ": " $1,110.69 ",
            " Max Reimb ": " $6,947.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL TUNNELED CV CATH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "36590",
            " Charge Amount ": " $4,566.83 ",
            " Min Reimb ": " $522.51 ",
            " Max Reimb ": " $3,196.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TEMPORAL ARTERY PROCEDURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "37609",
            " Charge Amount ": " $5,102.16 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $3,571.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPAROSCOPY SPLENECTOMY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "38120",
            " Charge Amount ": " $42,022.04 ",
            " Min Reimb ": " $2,641.84 ",
            " Max Reimb ": " $29,415.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BIOPSY/REMOVAL LYMPH NODES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "38500",
            " Charge Amount ": " $11,058.73 ",
            " Min Reimb ": " $1,638.67 ",
            " Max Reimb ": " $7,741.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BIOPSY/REMOVAL LYMPH NODES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "38510",
            " Charge Amount ": " $8,883.62 ",
            " Min Reimb ": " $1,638.67 ",
            " Max Reimb ": " $6,218.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BIOPSY/REMOVAL LYMPH NODES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "38525",
            " Charge Amount ": " $13,310.47 ",
            " Min Reimb ": " $1,638.67 ",
            " Max Reimb ": " $9,317.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "OPEN BX/EXC INGUINOFEM NODES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "38531",
            " Charge Amount ": " $6,043.73 ",
            " Min Reimb ": " $1,638.67 ",
            " Max Reimb ": " $4,230.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE ARMPIT LYMPH NODES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "38745",
            " Charge Amount ": " $23,405.84 ",
            " Min Reimb ": " $2,126.08 ",
            " Max Reimb ": " $16,384.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BIOPSY OF LIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "40490",
            " Charge Amount ": " $4,889.14 ",
            " Min Reimb ": " $189.57 ",
            " Max Reimb ": " $3,422.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PARTIAL EXCISION OF LIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "40510",
            " Charge Amount ": " $6,347.89 ",
            " Min Reimb ": " $1,113.49 ",
            " Max Reimb ": " $4,443.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RECONSTRUCT LIP WITH FLAP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "40525",
            " Charge Amount ": " $7,373.19 ",
            " Min Reimb ": " $1,950.20 ",
            " Max Reimb ": " $5,161.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PARTIAL REMOVAL OF LIP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "40530",
            " Charge Amount ": " $8,449.50 ",
            " Min Reimb ": " $1,287.56 ",
            " Max Reimb ": " $5,914.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXCISE/REPAIR MOUTH LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "40812",
            " Charge Amount ": " $5,127.78 ",
            " Min Reimb ": " $1,113.49 ",
            " Max Reimb ": " $3,589.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INCISION OF TONGUE FOLD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "41010",
            " Charge Amount ": " $8,006.45 ",
            " Min Reimb ": " $1,211.96 ",
            " Max Reimb ": " $5,604.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXCISION OF TONGUE LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "41112",
            " Charge Amount ": " $5,282.67 ",
            " Min Reimb ": " $1,113.49 ",
            " Max Reimb ": " $3,697.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXCISION OF TONGUE LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "41113",
            " Charge Amount ": " $5,864.33 ",
            " Min Reimb ": " $1,113.49 ",
            " Max Reimb ": " $4,105.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RECONSTRUCTION TONGUE FOLD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "41520",
            " Charge Amount ": " $4,101.10 ",
            " Min Reimb ": " $1,113.49 ",
            " Max Reimb ": " $2,871.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXCISION OF GUM FLAP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "41821",
            " Charge Amount ": " $9,539.45 ",
            " Min Reimb ": " $1,211.96 ",
            " Max Reimb ": " $6,677.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXCISION OF GUM LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "41826",
            " Charge Amount ": " $7,348.67 ",
            " Min Reimb ": " $2,451.53 ",
            " Max Reimb ": " $5,144.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR TOOTH SOCKET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "41874",
            " Charge Amount ": " $12,238.10 ",
            " Min Reimb ": " $2,451.53 ",
            " Max Reimb ": " $8,566.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DENTAL SURGERY PROCEDURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "41899",
            " Charge Amount ": " $6,511.09 ",
            " Min Reimb ": " $189.57 ",
            " Max Reimb ": " $4,557.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXCISION LESION MOUTH ROOF",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "42104",
            " Charge Amount ": " $4,813.86 ",
            " Min Reimb ": " $1,113.49 ",
            " Max Reimb ": " $3,369.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXCISION LESION MOUTH ROOF",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "42106",
            " Charge Amount ": " $5,234.45 ",
            " Min Reimb ": " $1,287.56 ",
            " Max Reimb ": " $3,664.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BIOPSY OF THROAT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "42800",
            " Charge Amount ": " $6,433.99 ",
            " Min Reimb ": " $1,211.96 ",
            " Max Reimb ": " $4,503.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE TONSILS AND ADENOIDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "42820",
            " Charge Amount ": " $7,581.09 ",
            " Min Reimb ": " $1,034.12 ",
            " Max Reimb ": " $5,306.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE TONSILS AND ADENOIDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "42821",
            " Charge Amount ": " $6,480.84 ",
            " Min Reimb ": " $1,034.12 ",
            " Max Reimb ": " $4,536.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF TONSILS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "42826",
            " Charge Amount ": " $6,401.57 ",
            " Min Reimb ": " $1,034.12 ",
            " Max Reimb ": " $4,481.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF ADENOIDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "42830",
            " Charge Amount ": " $8,886.97 ",
            " Min Reimb ": " $1,034.12 ",
            " Max Reimb ": " $6,220.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF ADENOIDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "42831",
            " Charge Amount ": " $6,897.46 ",
            " Min Reimb ": " $1,034.12 ",
            " Max Reimb ": " $4,828.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF ADENOIDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "42836",
            " Charge Amount ": " $7,699.38 ",
            " Min Reimb ": " $1,034.12 ",
            " Max Reimb ": " $5,389.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ESOPHAGOSCOPY RIGID TRNSO DX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43191",
            " Charge Amount ": " $7,952.49 ",
            " Min Reimb ": " $1,088.99 ",
            " Max Reimb ": " $5,566.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ESOPHAGOSCOPY LESION ABLATE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43229",
            " Charge Amount ": " $9,226.03 ",
            " Min Reimb ": " $1,088.99 ",
            " Max Reimb ": " $6,458.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EGD DIAGNOSTIC BRUSH WASH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43235",
            " Charge Amount ": " $4,756.13 ",
            " Min Reimb ": " $550.59 ",
            " Max Reimb ": " $3,329.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "UPPR GI SCOPE W/SUBMUC INJ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43236",
            " Charge Amount ": " $6,967.19 ",
            " Min Reimb ": " $550.59 ",
            " Max Reimb ": " $4,877.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EGD BIOPSY SINGLE/MULTIPLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43239",
            " Charge Amount ": " $4,799.37 ",
            " Min Reimb ": " $550.59 ",
            " Max Reimb ": " $3,359.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EGD VARICES LIGATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43244",
            " Charge Amount ": " $7,935.36 ",
            " Min Reimb ": " $550.59 ",
            " Max Reimb ": " $5,554.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EGD DILATE STRICTURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43245",
            " Charge Amount ": " $10,280.20 ",
            " Min Reimb ": " $550.59 ",
            " Max Reimb ": " $7,196.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EGD PLACE GASTROSTOMY TUBE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43246",
            " Charge Amount ": " $4,804.05 ",
            " Min Reimb ": " $550.59 ",
            " Max Reimb ": " $3,362.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EGD REMOVE FOREIGN BODY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43247",
            " Charge Amount ": " $8,141.79 ",
            " Min Reimb ": " $550.59 ",
            " Max Reimb ": " $5,699.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ESOPH EGD DILATION <30 MM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43249",
            " Charge Amount ": " $6,710.97 ",
            " Min Reimb ": " $550.59 ",
            " Max Reimb ": " $4,697.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EGD REMOVE LESION SNARE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43251",
            " Charge Amount ": " $7,691.04 ",
            " Min Reimb ": " $550.59 ",
            " Max Reimb ": " $5,383.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EGD CONTROL BLEEDING ANY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43255",
            " Charge Amount ": " $8,290.63 ",
            " Min Reimb ": " $550.59 ",
            " Max Reimb ": " $5,803.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EGD LESION ABLATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43270",
            " Charge Amount ": " $9,453.13 ",
            " Min Reimb ": " $1,088.99 ",
            " Max Reimb ": " $6,617.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPAROSCOPY FUNDOPLASTY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43280",
            " Charge Amount ": " $33,716.37 ",
            " Min Reimb ": " $2,641.84 ",
            " Max Reimb ": " $23,601.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAP PARAESOPHAG HERN REPAIR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43281",
            " Charge Amount ": " $35,214.59 ",
            " Min Reimb ": " $2,641.84 ",
            " Max Reimb ": " $24,650.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAP PARAESOPH HER RPR W/MESH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "43282",
            " Charge Amount ": " $32,573.59 ",
            " Min Reimb ": " $2,641.84 ",
            " Max Reimb ": " $22,801.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAP ENTEROLYSIS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "44180",
            " Charge Amount ": " $12,032.84 ",
            " Min Reimb ": " $2,299.42 ",
            " Max Reimb ": " $8,422.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COLONOSCOPY THRU STOMA SPX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "44388",
            " Charge Amount ": " $4,933.61 ",
            " Min Reimb ": " $576.42 ",
            " Max Reimb ": " $3,453.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COLONOSCOPY WITH BIOPSY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "44389",
            " Charge Amount ": " $3,940.84 ",
            " Min Reimb ": " $576.42 ",
            " Max Reimb ": " $2,758.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COLONOSCOPY W/SNARE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "44394",
            " Charge Amount ": " $4,637.48 ",
            " Min Reimb ": " $576.42 ",
            " Max Reimb ": " $3,246.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPAROSCOPY APPENDECTOMY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "44970",
            " Charge Amount ": " $21,673.36 ",
            " Min Reimb ": " $2,299.42 ",
            " Max Reimb ": " $15,171.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPAROSCOPE PROC APP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "44979",
            " Charge Amount ": " $24,140.21 ",
            " Min Reimb ": " $2,299.42 ",
            " Max Reimb ": " $16,898.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DRAINAGE OF RECTAL ABSCESS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45020",
            " Charge Amount ": " $6,644.19 ",
            " Min Reimb ": " $1,411.13 ",
            " Max Reimb ": " $4,650.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC RECT TUM TRANSANAL PART",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45171",
            " Charge Amount ": " $9,420.23 ",
            " Min Reimb ": " $1,411.13 ",
            " Max Reimb ": " $6,594.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXC RECT TUM TRANSANAL FULL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45172",
            " Charge Amount ": " $21,559.01 ",
            " Min Reimb ": " $1,411.13 ",
            " Max Reimb ": " $15,091.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DIAGNOSTIC SIGMOIDOSCOPY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45330",
            " Charge Amount ": " $3,203.39 ",
            " Min Reimb ": " $576.42 ",
            " Max Reimb ": " $2,242.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SIGMOIDOSCOPY AND BIOPSY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45331",
            " Charge Amount ": " $3,467.40 ",
            " Min Reimb ": " $576.42 ",
            " Max Reimb ": " $2,427.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SIGMOIDOSCOPY W/SUBMUC INJ",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45335",
            " Charge Amount ": " $3,081.80 ",
            " Min Reimb ": " $576.42 ",
            " Max Reimb ": " $2,157.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SIGMOIDOSCOPY W/TUMR REMOVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45338",
            " Charge Amount ": " $5,473.78 ",
            " Min Reimb ": " $576.42 ",
            " Max Reimb ": " $3,831.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SIG W/TNDSC BALLOON DILATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45340",
            " Charge Amount ": " $4,868.93 ",
            " Min Reimb ": " $576.42 ",
            " Max Reimb ": " $3,408.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DIAGNOSTIC COLONOSCOPY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45378",
            " Charge Amount ": " $3,817.38 ",
            " Min Reimb ": " $528.90 ",
            " Max Reimb ": " $2,672.17 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COLONOSCOPY AND BIOPSY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45380",
            " Charge Amount ": " $5,297.60 ",
            " Min Reimb ": " $528.90 ",
            " Max Reimb ": " $3,708.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COLONOSCOPY SUBMUCOUS NJX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45381",
            " Charge Amount ": " $8,852.17 ",
            " Min Reimb ": " $576.42 ",
            " Max Reimb ": " $6,196.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COLONOSCOPY W/CONTROL BLEED",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45382",
            " Charge Amount ": " $5,064.81 ",
            " Min Reimb ": " $576.42 ",
            " Max Reimb ": " $3,545.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COLONOSCOPY W/LESION REMOVAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45384",
            " Charge Amount ": " $4,965.59 ",
            " Min Reimb ": " $576.42 ",
            " Max Reimb ": " $3,475.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COLONOSCOPY W/LESION REMOVAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45385",
            " Charge Amount ": " $4,761.15 ",
            " Min Reimb ": " $576.42 ",
            " Max Reimb ": " $3,332.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COLONOSCOPY W/BALLOON DILAT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45386",
            " Charge Amount ": " $5,000.68 ",
            " Min Reimb ": " $576.42 ",
            " Max Reimb ": " $3,500.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COLONOSCOPY W/RESECTION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45390",
            " Charge Amount ": " $7,316.13 ",
            " Min Reimb ": " $781.78 ",
            " Max Reimb ": " $5,121.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE RECTAL OBSTRUCTION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45915",
            " Charge Amount ": " $8,371.38 ",
            " Min Reimb ": " $929.01 ",
            " Max Reimb ": " $5,859.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SURG DX EXAM ANORECTAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "45990",
            " Charge Amount ": " $9,628.73 ",
            " Min Reimb ": " $983.08 ",
            " Max Reimb ": " $6,740.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PLACEMENT OF SETON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46020",
            " Charge Amount ": " $8,135.31 ",
            " Min Reimb ": " $983.08 ",
            " Max Reimb ": " $5,694.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF RECTAL MARKER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46030",
            " Charge Amount ": " $3,906.16 ",
            " Min Reimb ": " $929.01 ",
            " Max Reimb ": " $2,734.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INCISION OF RECTAL ABSCESS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46045",
            " Charge Amount ": " $9,137.51 ",
            " Min Reimb ": " $1,411.13 ",
            " Max Reimb ": " $6,396.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INCISION OF ANAL ABSCESS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46050",
            " Charge Amount ": " $8,669.36 ",
            " Min Reimb ": " $711.03 ",
            " Max Reimb ": " $6,068.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXCISE ANAL EXT TAG/PAPILLA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46220",
            " Charge Amount ": " $5,348.36 ",
            " Min Reimb ": " $929.01 ",
            " Max Reimb ": " $3,743.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF ANAL TAGS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46230",
            " Charge Amount ": " $8,004.43 ",
            " Min Reimb ": " $983.08 ",
            " Max Reimb ": " $5,603.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE INT/EXT HEM 1 GROUP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46255",
            " Charge Amount ": " $10,866.26 ",
            " Min Reimb ": " $1,411.13 ",
            " Max Reimb ": " $7,606.38 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE IN/EX HEM GROUPS 2+",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46260",
            " Charge Amount ": " $9,184.21 ",
            " Min Reimb ": " $1,411.13 ",
            " Max Reimb ": " $6,428.95 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE ANAL FIST INTER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46275",
            " Charge Amount ": " $8,240.16 ",
            " Min Reimb ": " $1,411.13 ",
            " Max Reimb ": " $5,768.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE ANAL FIST COMPLEX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46280",
            " Charge Amount ": " $7,313.55 ",
            " Min Reimb ": " $1,411.13 ",
            " Max Reimb ": " $5,119.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE ANAL FIST 2 STAGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46285",
            " Charge Amount ": " $4,953.67 ",
            " Min Reimb ": " $983.08 ",
            " Max Reimb ": " $3,467.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CHEMODENERVATION ANAL MUSC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46505",
            " Charge Amount ": " $7,526.84 ",
            " Min Reimb ": " $929.01 ",
            " Max Reimb ": " $5,268.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DESTRUCTION ANAL LESION(S)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46910",
            " Charge Amount ": " $8,576.56 ",
            " Min Reimb ": " $983.08 ",
            " Max Reimb ": " $6,003.59 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXCISION OF ANAL LESION(S)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46922",
            " Charge Amount ": " $6,768.39 ",
            " Min Reimb ": " $983.08 ",
            " Max Reimb ": " $4,737.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DESTRUCTION ANAL LESION(S)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46924",
            " Charge Amount ": " $6,328.06 ",
            " Min Reimb ": " $983.08 ",
            " Max Reimb ": " $4,429.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ANUS SURGERY PROCEDURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "46999",
            " Charge Amount ": " $5,606.28 ",
            " Min Reimb ": " $711.03 ",
            " Max Reimb ": " $3,924.39 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NEEDLE BIOPSY OF LIVER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "47000",
            " Charge Amount ": " $5,664.51 ",
            " Min Reimb ": " $525.31 ",
            " Max Reimb ": " $3,965.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPAROSCOPIC CHOLECYSTECTOMY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "47562",
            " Charge Amount ": " $16,425.66 ",
            " Min Reimb ": " $2,299.42 ",
            " Max Reimb ": " $11,497.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPARO CHOLECYSTECTOMY/GRAPH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "47563",
            " Charge Amount ": " $23,954.77 ",
            " Min Reimb ": " $2,299.42 ",
            " Max Reimb ": " $16,768.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PERITONEAL LAVAGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49084",
            " Charge Amount ": " $12,640.52 ",
            " Min Reimb ": " $525.31 ",
            " Max Reimb ": " $8,848.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BIOPSY ABDOMINAL MASS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49180",
            " Charge Amount ": " $6,656.35 ",
            " Min Reimb ": " $525.31 ",
            " Max Reimb ": " $4,659.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DIAG LAPARO SEPARATE PROC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49320",
            " Charge Amount ": " $14,057.53 ",
            " Min Reimb ": " $1,581.79 ",
            " Max Reimb ": " $9,840.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPAROSCOPY BIOPSY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49321",
            " Charge Amount ": " $15,592.41 ",
            " Min Reimb ": " $1,581.79 ",
            " Max Reimb ": " $10,914.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPAROSCOPY ASPIRATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49322",
            " Charge Amount ": " $11,909.71 ",
            " Min Reimb ": " $1,581.79 ",
            " Max Reimb ": " $8,336.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAP INSERT TUNNEL IP CATH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49324",
            " Charge Amount ": " $10,998.36 ",
            " Min Reimb ": " $1,581.79 ",
            " Max Reimb ": " $7,698.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAP REVISION PERM IP CATH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49325",
            " Charge Amount ": " $8,585.18 ",
            " Min Reimb ": " $1,581.79 ",
            " Max Reimb ": " $6,009.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPARO PROC ABDM/PER/OMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49329",
            " Charge Amount ": " $13,638.27 ",
            " Min Reimb ": " $1,581.79 ",
            " Max Reimb ": " $9,546.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE TUNNELED IP CATH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49422",
            " Charge Amount ": " $4,706.53 ",
            " Min Reimb ": " $525.31 ",
            " Max Reimb ": " $3,294.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PRP I/HERN INIT REDUC >5 YR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49505",
            " Charge Amount ": " $13,010.90 ",
            " Min Reimb ": " $1,774.15 ",
            " Max Reimb ": " $9,107.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PRP I/HERN INIT BLOCK >5 YR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49507",
            " Charge Amount ": " $18,058.74 ",
            " Min Reimb ": " $1,774.15 ",
            " Max Reimb ": " $12,641.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REREPAIR ING HERNIA REDUCE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49520",
            " Charge Amount ": " $16,064.82 ",
            " Min Reimb ": " $1,774.15 ",
            " Max Reimb ": " $11,245.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR ING HERNIA SLIDING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49525",
            " Charge Amount ": " $15,589.47 ",
            " Min Reimb ": " $1,774.15 ",
            " Max Reimb ": " $10,912.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RPR VENTRAL HERN INIT REDUC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49560",
            " Charge Amount ": " $14,312.18 ",
            " Min Reimb ": " $1,774.15 ",
            " Max Reimb ": " $10,018.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RPR VENTRAL HERN INIT BLOCK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49561",
            " Charge Amount ": " $18,999.16 ",
            " Min Reimb ": " $1,774.15 ",
            " Max Reimb ": " $13,299.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REREPAIR VENTRL HERN REDUCE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49565",
            " Charge Amount ": " $20,700.61 ",
            " Min Reimb ": " $1,774.15 ",
            " Max Reimb ": " $14,490.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RPR EPIGASTRIC HERN REDUCE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49570",
            " Charge Amount ": " $15,113.17 ",
            " Min Reimb ": " $1,774.15 ",
            " Max Reimb ": " $10,579.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RPR UMBIL HERN REDUC > 5 YR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49585",
            " Charge Amount ": " $8,530.74 ",
            " Min Reimb ": " $1,774.15 ",
            " Max Reimb ": " $5,971.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RPR UMBIL HERN BLOCK > 5 YR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49587",
            " Charge Amount ": " $13,456.73 ",
            " Min Reimb ": " $1,774.15 ",
            " Max Reimb ": " $9,419.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR SPIGELIAN HERNIA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49590",
            " Charge Amount ": " $23,270.25 ",
            " Min Reimb ": " $1,774.15 ",
            " Max Reimb ": " $16,289.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAP ING HERNIA REPAIR INIT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49650",
            " Charge Amount ": " $22,405.83 ",
            " Min Reimb ": " $2,299.42 ",
            " Max Reimb ": " $15,684.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAP ING HERNIA REPAIR RECUR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49651",
            " Charge Amount ": " $26,534.58 ",
            " Min Reimb ": " $2,299.42 ",
            " Max Reimb ": " $18,574.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAP VENT/ABD HERNIA REPAIR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49652",
            " Charge Amount ": " $23,990.88 ",
            " Min Reimb ": " $2,299.42 ",
            " Max Reimb ": " $16,793.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAP VENT/ABD HERN PROC COMP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49653",
            " Charge Amount ": " $27,473.46 ",
            " Min Reimb ": " $2,299.42 ",
            " Max Reimb ": " $19,231.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAP INC HERNIA REPAIR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49654",
            " Charge Amount ": " $25,076.51 ",
            " Min Reimb ": " $2,299.42 ",
            " Max Reimb ": " $17,553.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAP INC HERN REPAIR COMP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49655",
            " Charge Amount ": " $25,126.10 ",
            " Min Reimb ": " $2,299.42 ",
            " Max Reimb ": " $17,588.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAP INC HERNIA REPAIR RECUR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49656",
            " Charge Amount ": " $26,768.17 ",
            " Min Reimb ": " $2,299.42 ",
            " Max Reimb ": " $18,737.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPARO PROC HERNIA REPAIR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "49659",
            " Charge Amount ": " $22,640.66 ",
            " Min Reimb ": " $1,581.79 ",
            " Max Reimb ": " $15,848.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF KIDNEY STONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "50081",
            " Charge Amount ": " $21,562.02 ",
            " Min Reimb ": " $7,398.46 ",
            " Max Reimb ": " $15,093.42 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DRAINAGE OF KIDNEY LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "50390",
            " Charge Amount ": " $5,452.63 ",
            " Min Reimb ": " $338.74 ",
            " Max Reimb ": " $3,816.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "FRAGMENTING OF KIDNEY STONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "50590",
            " Charge Amount ": " $13,273.89 ",
            " Min Reimb ": " $2,756.09 ",
            " Max Reimb ": " $9,291.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CHANGE OF URETER TUBE/STENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "50688",
            " Charge Amount ": " $7,657.13 ",
            " Min Reimb ": " $1,606.34 ",
            " Max Reimb ": " $5,359.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INCISE & DRAIN BLADDER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "51040",
            " Charge Amount ": " $6,213.30 ",
            " Min Reimb ": " $1,606.34 ",
            " Max Reimb ": " $4,349.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DRAIN BL W/CATH INSERTION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "51102",
            " Charge Amount ": " $7,302.56 ",
            " Min Reimb ": " $1,606.34 ",
            " Max Reimb ": " $5,111.79 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOSCOPY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52000",
            " Charge Amount ": " $5,689.62 ",
            " Min Reimb ": " $514.94 ",
            " Max Reimb ": " $3,982.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOSCOPY & URETER CATHETER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52005",
            " Charge Amount ": " $7,530.63 ",
            " Min Reimb ": " $1,606.34 ",
            " Max Reimb ": " $5,271.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOSCOPY W/BIOPSY(S)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52204",
            " Charge Amount ": " $7,692.21 ",
            " Min Reimb ": " $1,606.34 ",
            " Max Reimb ": " $5,384.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOSCOPY AND TREATMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52214",
            " Charge Amount ": " $9,881.54 ",
            " Min Reimb ": " $2,756.09 ",
            " Max Reimb ": " $6,917.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOSCOPY AND TREATMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52224",
            " Charge Amount ": " $7,976.07 ",
            " Min Reimb ": " $2,756.09 ",
            " Max Reimb ": " $5,583.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOSCOPY AND TREATMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52234",
            " Charge Amount ": " $9,522.17 ",
            " Min Reimb ": " $2,756.09 ",
            " Max Reimb ": " $6,665.52 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOSCOPY AND TREATMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52235",
            " Charge Amount ": " $12,190.58 ",
            " Min Reimb ": " $2,756.09 ",
            " Max Reimb ": " $8,533.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOSCOPY AND TREATMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52240",
            " Charge Amount ": " $14,410.33 ",
            " Min Reimb ": " $3,954.41 ",
            " Max Reimb ": " $10,087.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOSCOPY AND TREATMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52260",
            " Charge Amount ": " $6,696.69 ",
            " Min Reimb ": " $1,606.34 ",
            " Max Reimb ": " $4,687.68 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOSCOPY AND TREATMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52276",
            " Charge Amount ": " $8,667.21 ",
            " Min Reimb ": " $675.20 ",
            " Max Reimb ": " $6,067.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOSCOPY AND TREATMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52281",
            " Charge Amount ": " $7,358.84 ",
            " Min Reimb ": " $1,606.34 ",
            " Max Reimb ": " $5,151.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOSCOPY CHEMODENERVATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52287",
            " Charge Amount ": " $8,587.09 ",
            " Min Reimb ": " $1,606.34 ",
            " Max Reimb ": " $6,010.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOSCOPY AND TREATMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52310",
            " Charge Amount ": " $6,731.10 ",
            " Min Reimb ": " $1,606.34 ",
            " Max Reimb ": " $4,711.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE BLADDER STONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52317",
            " Charge Amount ": " $10,934.92 ",
            " Min Reimb ": " $2,756.09 ",
            " Max Reimb ": " $7,654.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE BLADDER STONE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52318",
            " Charge Amount ": " $12,444.97 ",
            " Min Reimb ": " $2,756.09 ",
            " Max Reimb ": " $8,711.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOSCOPY AND TREATMENT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52332",
            " Charge Amount ": " $10,316.33 ",
            " Min Reimb ": " $2,756.09 ",
            " Max Reimb ": " $7,221.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTO/URETERO STRICTURE TX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52344",
            " Charge Amount ": " $10,933.10 ",
            " Min Reimb ": " $2,756.09 ",
            " Max Reimb ": " $7,653.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOURETERO & OR PYELOSCOPE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52351",
            " Charge Amount ": " $7,880.62 ",
            " Min Reimb ": " $2,756.09 ",
            " Max Reimb ": " $5,516.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOURETERO W/STONE REMOVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52352",
            " Charge Amount ": " $11,674.31 ",
            " Min Reimb ": " $2,756.09 ",
            " Max Reimb ": " $8,172.02 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOURETERO W/LITHOTRIPSY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52353",
            " Charge Amount ": " $15,668.55 ",
            " Min Reimb ": " $3,954.41 ",
            " Max Reimb ": " $10,967.99 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOURETERO W/BIOPSY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52354",
            " Charge Amount ": " $13,329.68 ",
            " Min Reimb ": " $3,954.41 ",
            " Max Reimb ": " $9,330.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTO/URETERO W/LITHOTRIPSY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52356",
            " Charge Amount ": " $12,992.37 ",
            " Min Reimb ": " $3,954.41 ",
            " Max Reimb ": " $9,094.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOURETHRO W/IMPLANT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52441",
            " Charge Amount ": " $28,570.05 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19,999.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISION OF BLADDER NECK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52500",
            " Charge Amount ": " $13,389.43 ",
            " Min Reimb ": " $2,756.09 ",
            " Max Reimb ": " $9,372.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PROSTATECTOMY (TURP)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52601",
            " Charge Amount ": " $16,119.21 ",
            " Min Reimb ": " $2,095.91 ",
            " Max Reimb ": " $11,283.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE PROSTATE REGROWTH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "52630",
            " Charge Amount ": " $11,731.32 ",
            " Min Reimb ": " $2,095.91 ",
            " Max Reimb ": " $8,211.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF URETHRA LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "53230",
            " Charge Amount ": " $25,051.37 ",
            " Min Reimb ": " $1,086.40 ",
            " Max Reimb ": " $17,535.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREATMENT OF URETHRA LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "53260",
            " Charge Amount ": " $9,630.11 ",
            " Min Reimb ": " $675.20 ",
            " Max Reimb ": " $6,741.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREATMENT OF URETHRA LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "53265",
            " Charge Amount ": " $6,490.93 ",
            " Min Reimb ": " $675.20 ",
            " Max Reimb ": " $4,543.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MALE SLING PROCEDURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "53440",
            " Charge Amount ": " $36,586.19 ",
            " Min Reimb ": " $1,086.40 ",
            " Max Reimb ": " $25,610.33 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "URETHRLYS TRANSVAG W/ SCOPE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "53500",
            " Charge Amount ": " $13,328.52 ",
            " Min Reimb ": " $675.20 ",
            " Max Reimb ": " $9,329.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "UROLOGY SURGERY PROCEDURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "53899",
            " Charge Amount ": " $10,857.34 ",
            " Min Reimb ": " $238.43 ",
            " Max Reimb ": " $7,600.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "SLITTING OF PREPUCE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "54001",
            " Charge Amount ": " $5,524.19 ",
            " Min Reimb ": " $1,606.34 ",
            " Max Reimb ": " $3,866.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LASER SURG PENIS LESION(S)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "54057",
            " Charge Amount ": " $6,398.35 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $4,478.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DESTRUCTION PENIS LESION(S)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "54065",
            " Charge Amount ": " $6,612.98 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $4,629.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CIRCUM 28 DAYS OR OLDER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "54161",
            " Charge Amount ": " $6,981.63 ",
            " Min Reimb ": " $1,606.34 ",
            " Max Reimb ": " $4,887.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INSERT MULTI-COMP PENIS PROS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "54405",
            " Charge Amount ": " $62,111.93 ",
            " Min Reimb ": " $3,413.26 ",
            " Max Reimb ": " $43,478.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PREPUTIAL STRETCHING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "54450",
            " Charge Amount ": " $4,415.53 ",
            " Min Reimb ": " $238.43 ",
            " Max Reimb ": " $3,090.87 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF TESTIS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "54520",
            " Charge Amount ": " $9,681.72 ",
            " Min Reimb ": " $1,541.67 ",
            " Max Reimb ": " $6,777.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF TESTIS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "54530",
            " Charge Amount ": " $14,155.00 ",
            " Min Reimb ": " $1,876.86 ",
            " Max Reimb ": " $9,908.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE EPIDIDYMIS LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "54840",
            " Charge Amount ": " $7,840.49 ",
            " Min Reimb ": " $1,541.67 ",
            " Max Reimb ": " $5,488.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF HYDROCELE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "55040",
            " Charge Amount ": " $7,220.07 ",
            " Min Reimb ": " $1,876.86 ",
            " Max Reimb ": " $5,054.05 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF HYDROCELES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "55041",
            " Charge Amount ": " $8,505.25 ",
            " Min Reimb ": " $1,876.86 ",
            " Max Reimb ": " $5,953.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF SPERM DUCT(S)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "55250",
            " Charge Amount ": " $5,051.34 ",
            " Min Reimb ": " $1,541.67 ",
            " Max Reimb ": " $3,535.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR OF SPERM DUCT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "55400",
            " Charge Amount ": " $11,852.26 ",
            " Min Reimb ": " $1,876.86 ",
            " Max Reimb ": " $8,296.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE SPERMATIC CORD VEINS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "55530",
            " Charge Amount ": " $6,206.72 ",
            " Min Reimb ": " $1,876.86 ",
            " Max Reimb ": " $4,344.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPARO LIGATE SPERMATIC VEIN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "55550",
            " Charge Amount ": " $10,930.86 ",
            " Min Reimb ": " $1,876.86 ",
            " Max Reimb ": " $7,651.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BIOPSY OF PROSTATE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "55700",
            " Charge Amount ": " $9,452.32 ",
            " Min Reimb ": " $1,606.34 ",
            " Max Reimb ": " $6,616.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPARO RADICAL PROSTATECTOMY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "55866",
            " Charge Amount ": " $52,994.99 ",
            " Min Reimb ": " $2,641.84 ",
            " Max Reimb ": " $37,096.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "GENITAL SURGERY PROCEDURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "55899",
            " Charge Amount ": " $10,188.89 ",
            " Min Reimb ": " $238.43 ",
            " Max Reimb ": " $7,132.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LYSIS OF LABIAL LESION(S)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "56441",
            " Charge Amount ": " $7,723.98 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $5,406.78 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DESTROY VULVA LESION/S COMPL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "56515",
            " Charge Amount ": " $6,375.90 ",
            " Min Reimb ": " $1,536.79 ",
            " Max Reimb ": " $4,463.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PARTIAL REMOVAL OF VULVA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "56620",
            " Charge Amount ": " $7,416.37 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $5,191.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PARTIAL REMOVAL OF HYMEN",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "56700",
            " Charge Amount ": " $4,969.47 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $3,478.63 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE VAGINA GLAND LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "56740",
            " Charge Amount ": " $5,469.59 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $3,828.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DESTROY VAG LESIONS SIMPLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57061",
            " Charge Amount ": " $7,040.15 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $4,928.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DESTROY VAG LESIONS COMPLEX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57065",
            " Charge Amount ": " $9,466.72 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $6,626.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE VAGINA LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57130",
            " Charge Amount ": " $7,937.60 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $5,556.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE VAGINA LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57135",
            " Charge Amount ": " $5,115.85 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $3,581.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ANTERIOR COLPORRHAPHY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57240",
            " Charge Amount ": " $14,924.35 ",
            " Min Reimb ": " $675.20 ",
            " Max Reimb ": " $10,447.04 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR RECTUM & VAGINA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57250",
            " Charge Amount ": " $17,082.74 ",
            " Min Reimb ": " $983.08 ",
            " Max Reimb ": " $11,957.92 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CMBN ANT PST COLPRHY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57260",
            " Charge Amount ": " $18,600.26 ",
            " Min Reimb ": " $675.20 ",
            " Max Reimb ": " $13,020.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COLPOPEXY EXTRAPERITONEAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57282",
            " Charge Amount ": " $31,695.83 ",
            " Min Reimb ": " $6,087.02 ",
            " Max Reimb ": " $22,187.08 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE/REMOVE SLING REPAIR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57287",
            " Charge Amount ": " $12,858.35 ",
            " Min Reimb ": " $675.20 ",
            " Max Reimb ": " $9,000.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR BLADDER DEFECT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57288",
            " Charge Amount ": " $13,406.13 ",
            " Min Reimb ": " $675.20 ",
            " Max Reimb ": " $9,384.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE VAG GRAFT VIA VAGINA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57295",
            " Charge Amount ": " $8,059.98 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $5,641.98 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR RECTUM-VAGINA FISTULA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57300",
            " Charge Amount ": " $17,787.43 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $12,451.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PELVIC EXAMINATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57410",
            " Charge Amount ": " $7,124.29 ",
            " Min Reimb ": " $141.28 ",
            " Max Reimb ": " $4,987.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPAROSCOPY SURG COLPOPEXY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57425",
            " Charge Amount ": " $40,025.56 ",
            " Min Reimb ": " $7,980.37 ",
            " Max Reimb ": " $28,017.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BX OF CERVIX W/SCOPE LEEP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57460",
            " Charge Amount ": " $8,795.49 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $6,156.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CONZ OF CERVIX W/SCOPE LEEP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57461",
            " Charge Amount ": " $10,449.26 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $7,314.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BIOPSY OF CERVIX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57500",
            " Charge Amount ": " $6,272.57 ",
            " Min Reimb ": " $567.47 ",
            " Max Reimb ": " $4,390.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CONIZATION OF CERVIX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57520",
            " Charge Amount ": " $5,530.10 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $3,871.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CONIZATION OF CERVIX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57522",
            " Charge Amount ": " $5,477.36 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $3,834.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF CERVIX",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "57530",
            " Charge Amount ": " $12,075.11 ",
            " Min Reimb ": " $3,950.51 ",
            " Max Reimb ": " $8,452.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MYOMECTOMY ABDOM METHOD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58140",
            " Charge Amount ": " $21,944.97 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15,361.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "MYOMECTOMY VAG METHOD",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58145",
            " Charge Amount ": " $33,190.88 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $23,233.62 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TOTAL HYSTERECTOMY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58150",
            " Charge Amount ": " $31,818.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $22,272.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "VAGINAL HYSTERECTOMY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58260",
            " Charge Amount ": " $20,303.81 ",
            " Min Reimb ": " $3,950.51 ",
            " Max Reimb ": " $14,212.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CATHETER FOR HYSTEROGRAPHY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58340",
            " Charge Amount ": " $5,154.97 ",
            " Min Reimb ": " $152.03 ",
            " Max Reimb ": " $3,608.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REOPEN FALLOPIAN TUBE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58350",
            " Charge Amount ": " $13,336.93 ",
            " Min Reimb ": " $3,950.51 ",
            " Max Reimb ": " $9,335.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LSH UTERUS 250 G OR LESS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58541",
            " Charge Amount ": " $33,291.63 ",
            " Min Reimb ": " $4,533.65 ",
            " Max Reimb ": " $23,304.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LSH W/T/O UT 250 G OR LESS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58542",
            " Charge Amount ": " $40,204.50 ",
            " Min Reimb ": " $7,980.37 ",
            " Max Reimb ": " $28,143.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPAROSCOPIC MYOMECTOMY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58545",
            " Charge Amount ": " $19,893.82 ",
            " Min Reimb ": " $4,533.65 ",
            " Max Reimb ": " $13,925.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "HYSTEROSCOPY DX SEP PROC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58555",
            " Charge Amount ": " $11,492.36 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $8,044.65 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "HYSTEROSCOPY BIOPSY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58558",
            " Charge Amount ": " $7,506.29 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $5,254.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "HYSTEROSCOPY LYSIS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58559",
            " Charge Amount ": " $8,459.62 ",
            " Min Reimb ": " $3,950.51 ",
            " Max Reimb ": " $5,921.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "HYSTEROSCOPY REMOVE MYOMA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58561",
            " Charge Amount ": " $11,174.96 ",
            " Min Reimb ": " $3,950.51 ",
            " Max Reimb ": " $7,822.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "HYSTEROSCOPY REMOVE FB",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58562",
            " Charge Amount ": " $6,066.73 ",
            " Min Reimb ": " $2,350.13 ",
            " Max Reimb ": " $4,246.71 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "HYSTEROSCOPY ABLATION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58563",
            " Charge Amount ": " $9,932.86 ",
            " Min Reimb ": " $3,950.51 ",
            " Max Reimb ": " $6,953.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TLH UTERUS 250 G OR LESS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58570",
            " Charge Amount ": " $27,758.08 ",
            " Min Reimb ": " $7,980.37 ",
            " Max Reimb ": " $19,430.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TLH W/T/O 250 G OR LESS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58571",
            " Charge Amount ": " $28,512.57 ",
            " Min Reimb ": " $7,980.37 ",
            " Max Reimb ": " $19,958.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TLH UTERUS OVER 250 G",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58572",
            " Charge Amount ": " $16,246.95 ",
            " Min Reimb ": " $7,980.37 ",
            " Max Reimb ": " $11,372.86 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TLH W/T/O UTERUS OVER 250 G",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58573",
            " Charge Amount ": " $29,755.08 ",
            " Min Reimb ": " $7,980.37 ",
            " Max Reimb ": " $20,828.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPARO PROC UTERUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58578",
            " Charge Amount ": " $14,071.62 ",
            " Min Reimb ": " $4,533.65 ",
            " Max Reimb ": " $9,850.13 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPAROSCOPY LYSIS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58660",
            " Charge Amount ": " $13,143.30 ",
            " Min Reimb ": " $4,533.65 ",
            " Max Reimb ": " $9,200.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPAROSCOPY REMOVE ADNEXA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58661",
            " Charge Amount ": " $12,330.46 ",
            " Min Reimb ": " $4,533.65 ",
            " Max Reimb ": " $8,631.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPAROSCOPY EXCISE LESIONS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58662",
            " Charge Amount ": " $13,720.64 ",
            " Min Reimb ": " $4,533.65 ",
            " Max Reimb ": " $9,604.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPAROSCOPY TUBAL CAUTERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58670",
            " Charge Amount ": " $10,629.88 ",
            " Min Reimb ": " $4,533.65 ",
            " Max Reimb ": " $7,440.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAPAROSCOPY TUBAL BLOCK",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58671",
            " Charge Amount ": " $9,033.55 ",
            " Min Reimb ": " $4,533.65 ",
            " Max Reimb ": " $6,323.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF OVARY/TUBE(S)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58720",
            " Charge Amount ": " $24,634.70 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $17,244.29 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF OVARIAN CYST(S)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58925",
            " Charge Amount ": " $14,030.26 ",
            " Min Reimb ": " $3,950.51 ",
            " Max Reimb ": " $9,821.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "GENITAL SURGERY PROCEDURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "58999",
            " Charge Amount ": " $4,174.32 ",
            " Min Reimb ": " $152.59 ",
            " Max Reimb ": " $2,922.03 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREAT ECTOPIC PREGNANCY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "59151",
            " Charge Amount ": " $18,355.16 ",
            " Min Reimb ": " $4,533.65 ",
            " Max Reimb ": " $12,848.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "TREATMENT OF MISCARRIAGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "59812",
            " Charge Amount ": " $6,578.23 ",
            " Min Reimb ": " $961.38 ",
            " Max Reimb ": " $4,604.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CARE OF MISCARRIAGE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "59820",
            " Charge Amount ": " $6,210.62 ",
            " Min Reimb ": " $961.38 ",
            " Max Reimb ": " $4,347.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PARTIAL REMOVAL OF THYROID",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "60220",
            " Charge Amount ": " $20,225.97 ",
            " Min Reimb ": " $4,533.65 ",
            " Max Reimb ": " $14,158.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF THYROID",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "60240",
            " Charge Amount ": " $23,487.04 ",
            " Min Reimb ": " $4,533.65 ",
            " Max Reimb ": " $16,440.93 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE THYROID DUCT LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "60280",
            " Charge Amount ": " $8,703.50 ",
            " Min Reimb ": " $4,533.65 ",
            " Max Reimb ": " $6,092.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXPLORE PARATHYROID GLANDS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "60500",
            " Charge Amount ": " $24,489.08 ",
            " Min Reimb ": " $4,556.59 ",
            " Max Reimb ": " $17,142.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "BRAIN CANAL SHUNT PROCEDURE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "61070",
            " Charge Amount ": " $6,741.19 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $4,718.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EPIDURAL LYSIS ON SINGLE DAY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "62264",
            " Charge Amount ": " $5,776.04 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $4,043.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX PX DISCOGRAPHY LUMBAR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "62290",
            " Charge Amount ": " $9,068.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $6,348.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX INTERLAMINAR CRV/THRC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "62320",
            " Charge Amount ": " $2,775.10 ",
            " Min Reimb ": " $568.53 ",
            " Max Reimb ": " $1,942.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX INTERLAMINAR CRV/THRC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "62321",
            " Charge Amount ": " $3,267.45 ",
            " Min Reimb ": " $568.53 ",
            " Max Reimb ": " $2,287.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX INTERLAMINAR LMBR/SAC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "62322",
            " Charge Amount ": " $11,257.15 ",
            " Min Reimb ": " $568.53 ",
            " Max Reimb ": " $7,880.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX INTERLAMINAR LMBR/SAC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "62323",
            " Charge Amount ": " $3,594.50 ",
            " Min Reimb ": " $568.53 ",
            " Max Reimb ": " $2,516.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX INTERLAMINAR CRV/THRC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "62325",
            " Charge Amount ": " $3,266.41 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $2,286.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX INTERLAMINAR LMBR/SAC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "62327",
            " Charge Amount ": " $5,309.44 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $3,716.61 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "IMPLANT SPINAL CANAL CATH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "62350",
            " Charge Amount ": " $58,781.10 ",
            " Min Reimb ": " $1,998.49 ",
            " Max Reimb ": " $41,146.77 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "IMPLANT SPINE INFUSION PUMP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "62362",
            " Charge Amount ": " $50,567.98 ",
            " Min Reimb ": " $11,508.83 ",
            " Max Reimb ": " $35,397.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE SPINE INFUSION DEVICE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "62365",
            " Charge Amount ": " $16,273.08 ",
            " Min Reimb ": " $1,049.80 ",
            " Max Reimb ": " $11,391.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ANALYZE SP INF PUMP W/REPROG",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "62368",
            " Charge Amount ": " $981.28 ",
            " Min Reimb ": " $171.10 ",
            " Max Reimb ": " $686.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ANL SP INF PMP W/MDREPRG&FIL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "62370",
            " Charge Amount ": " $2,150.53 ",
            " Min Reimb ": " $171.10 ",
            " Max Reimb ": " $1,505.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LOW BACK DISK SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "63030",
            " Charge Amount ": " $22,180.37 ",
            " Min Reimb ": " $2,684.15 ",
            " Max Reimb ": " $15,526.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "LAMINOTOMY SINGLE LUMBAR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "63042",
            " Charge Amount ": " $20,077.09 ",
            " Min Reimb ": " $2,684.15 ",
            " Max Reimb ": " $14,053.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE SPINE LAMINA 1 THRC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "63046",
            " Charge Amount ": " $164,504.13 ",
            " Min Reimb ": " $2,684.15 ",
            " Max Reimb ": " $115,152.89 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE SPINE LAMINA 1 LMBR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "63047",
            " Charge Amount ": " $36,304.81 ",
            " Min Reimb ": " $2,684.15 ",
            " Max Reimb ": " $25,413.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DECOMPRESS SPINAL CORD LMBR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "63056",
            " Charge Amount ": " $19,316.20 ",
            " Min Reimb ": " $2,684.15 ",
            " Max Reimb ": " $13,521.34 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "IMPLANT NEUROELECTRODES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "63650",
            " Charge Amount ": " $19,384.45 ",
            " Min Reimb ": " $1,998.49 ",
            " Max Reimb ": " $13,569.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "IMPLANT NEUROELECTRODES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "63655",
            " Charge Amount ": " $33,206.09 ",
            " Min Reimb ": " $4,733.76 ",
            " Max Reimb ": " $23,244.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE SPINE ELTRD PERQ ARAY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "63663",
            " Charge Amount ": " $7,831.85 ",
            " Min Reimb ": " $1,998.49 ",
            " Max Reimb ": " $5,482.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE SPINE ELTRD PLATE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "63664",
            " Charge Amount ": " $25,165.85 ",
            " Min Reimb ": " $10,066.52 ",
            " Max Reimb ": " $17,616.09 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INSRT/REDO SPINE N GENERATOR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "63685",
            " Charge Amount ": " $73,595.46 ",
            " Min Reimb ": " $17,123.17 ",
            " Max Reimb ": " $51,516.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE/REMOVE NEURORECEIVER",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "63688",
            " Charge Amount ": " $11,155.37 ",
            " Min Reimb ": " $1,998.49 ",
            " Max Reimb ": " $7,808.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX AA&/STRD TRIGEMINAL NRV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64400",
            " Charge Amount ": " $1,486.12 ",
            " Min Reimb ": " $233.98 ",
            " Max Reimb ": " $1,040.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX AA&/STRD GR OCPL NRV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64405",
            " Charge Amount ": " $2,824.91 ",
            " Min Reimb ": " $233.98 ",
            " Max Reimb ": " $1,977.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX AA&/STRD NTRCOST NRV 1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64420",
            " Charge Amount ": " $4,182.07 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $2,927.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX AA&/STRD NTRCOST NRV EA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64421",
            " Charge Amount ": " $5,186.85 ",
            " Min Reimb ": " $588.77 ",
            " Max Reimb ": " $3,630.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX AA&/STRD II IH NERVES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64425",
            " Charge Amount ": " $1,932.38 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $1,352.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX AA&/STRD SCIATIC NERVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64445",
            " Charge Amount ": " $2,312.58 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $1,618.81 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX AA&/STRD FEMORAL NERVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64447",
            " Charge Amount ": " $4,548.06 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $3,183.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX AA&/STRD OTHER PN/BRANCH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64450",
            " Charge Amount ": " $3,618.01 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $2,532.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX AA&/STRD NRV NRVTG SI JT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64451",
            " Charge Amount ": " $3,757.06 ",
            " Min Reimb ": " $426.37 ",
            " Max Reimb ": " $2,629.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX AA&/STRD GNCLR NRV BRNCH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64454",
            " Charge Amount ": " $3,812.11 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $2,668.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX AA&/STRD TFRM EPI C/T 1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64479",
            " Charge Amount ": " $4,928.94 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $3,450.26 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX AA&/STRD TFRM EPI L/S 1",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64483",
            " Charge Amount ": " $3,595.29 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $2,516.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INJ PARAVERT F JNT C/T 1 LEV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64490",
            " Charge Amount ": " $5,379.64 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $3,765.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INJ PARAVERT F JNT L/S 1 LEV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64493",
            " Charge Amount ": " $5,651.93 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $3,956.35 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "N BLOCK STELLATE GANGLION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64510",
            " Charge Amount ": " $3,068.21 ",
            " Min Reimb ": " $588.77 ",
            " Max Reimb ": " $2,147.75 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "N BLOCK LUMBAR/THORACIC",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64520",
            " Charge Amount ": " $3,963.43 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $2,774.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "IMPLANT NEUROELECTRODES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64561",
            " Charge Amount ": " $20,604.69 ",
            " Min Reimb ": " $1,998.49 ",
            " Max Reimb ": " $14,423.28 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE/REMOVE NEUROELECTRODE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64585",
            " Charge Amount ": " $5,649.08 ",
            " Min Reimb ": " $1,049.80 ",
            " Max Reimb ": " $3,954.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INSRT/REDO PN/GASTR STIMUL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64590",
            " Charge Amount ": " $53,823.48 ",
            " Min Reimb ": " $11,508.83 ",
            " Max Reimb ": " $37,676.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE/RMV PN/GASTR STIMUL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64595",
            " Charge Amount ": " $9,942.10 ",
            " Min Reimb ": " $1,998.49 ",
            " Max Reimb ": " $6,959.47 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CHEMODENERV MUSC MIGRAINE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64615",
            " Charge Amount ": " $5,071.04 ",
            " Min Reimb ": " $233.98 ",
            " Max Reimb ": " $3,549.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CHEMODENERV MUSC NECK DYSTON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64616",
            " Charge Amount ": " $5,107.72 ",
            " Min Reimb ": " $233.98 ",
            " Max Reimb ": " $3,575.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DSTRJ NULYT AGT GNCLR NRV",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64624",
            " Charge Amount ": " $5,298.13 ",
            " Min Reimb ": " $588.77 ",
            " Max Reimb ": " $3,708.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "RF ABLTJ NRV NRVTG SI JT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64625",
            " Charge Amount ": " $6,452.65 ",
            " Min Reimb ": " $1,049.80 ",
            " Max Reimb ": " $4,516.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DESTROY CERV/THOR FACET JNT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64633",
            " Charge Amount ": " $9,342.81 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $6,539.97 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DESTROY LUMB/SAC FACET JNT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64635",
            " Charge Amount ": " $9,498.05 ",
            " Min Reimb ": " $643.90 ",
            " Max Reimb ": " $6,648.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INJECTION TREATMENT OF NERVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64640",
            " Charge Amount ": " $13,952.80 ",
            " Min Reimb ": " $588.77 ",
            " Max Reimb ": " $9,766.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CHEMODENERV 1 EXTREMITY 1-4",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64642",
            " Charge Amount ": " $6,528.96 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $4,570.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CHEMODENERV 1 EXTREM 5/> MUS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64644",
            " Charge Amount ": " $10,126.42 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $7,088.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE HAND/FOOT NERVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64704",
            " Charge Amount ": " $10,626.42 ",
            " Min Reimb ": " $1,049.80 ",
            " Max Reimb ": " $7,438.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE ARM/LEG NERVE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64708",
            " Charge Amount ": " $5,618.68 ",
            " Min Reimb ": " $1,049.80 ",
            " Max Reimb ": " $3,933.07 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE ULNAR NERVE AT ELBOW",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64718",
            " Charge Amount ": " $8,754.45 ",
            " Min Reimb ": " $1,049.80 ",
            " Max Reimb ": " $6,128.12 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CARPAL TUNNEL SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64721",
            " Charge Amount ": " $6,875.35 ",
            " Min Reimb ": " $1,049.80 ",
            " Max Reimb ": " $4,812.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE DIGIT NERVE LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64776",
            " Charge Amount ": " $5,900.35 ",
            " Min Reimb ": " $1,049.80 ",
            " Max Reimb ": " $4,130.25 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NERVOUS SYSTEM SURGERY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "64999",
            " Charge Amount ": " $3,901.96 ",
            " Min Reimb ": " $233.98 ",
            " Max Reimb ": " $2,731.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVAL OF EYE LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "65426",
            " Charge Amount ": " $4,408.78 ",
            " Min Reimb ": " $1,254.22 ",
            " Max Reimb ": " $3,086.15 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INCISION OF EYE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "66172",
            " Charge Amount ": " $8,616.55 ",
            " Min Reimb ": " $1,254.22 ",
            " Max Reimb ": " $6,031.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "FOLLOW-UP SURGERY OF EYE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "66250",
            " Charge Amount ": " $7,136.49 ",
            " Min Reimb ": " $837.60 ",
            " Max Reimb ": " $4,995.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "XCAPSL CTRC RMVL CPLX WO ECP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "66982",
            " Charge Amount ": " $13,012.87 ",
            " Min Reimb ": " $997.06 ",
            " Max Reimb ": " $9,109.01 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "XCAPSL CTRC RMVL W/O ECP",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "66984",
            " Charge Amount ": " $11,431.14 ",
            " Min Reimb ": " $997.06 ",
            " Max Reimb ": " $8,001.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE EYE MUSCLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "67311",
            " Charge Amount ": " $8,732.05 ",
            " Min Reimb ": " $1,464.61 ",
            " Max Reimb ": " $6,112.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE TWO EYE MUSCLES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "67312",
            " Charge Amount ": " $9,555.34 ",
            " Min Reimb ": " $1,464.61 ",
            " Max Reimb ": " $6,688.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE EYE MUSCLE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "67314",
            " Charge Amount ": " $11,636.78 ",
            " Min Reimb ": " $1,464.61 ",
            " Max Reimb ": " $8,145.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXPLORE/TREAT EYE SOCKET",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "67412",
            " Charge Amount ": " $5,045.47 ",
            " Min Reimb ": " $1,295.40 ",
            " Max Reimb ": " $3,531.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE EYELID LESION(S)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "67808",
            " Charge Amount ": " $5,448.57 ",
            " Min Reimb ": " $638.31 ",
            " Max Reimb ": " $3,813.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE EYELID LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "67840",
            " Charge Amount ": " $7,512.38 ",
            " Min Reimb ": " $638.31 ",
            " Max Reimb ": " $5,258.67 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR EYELID DEFECT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "67903",
            " Charge Amount ": " $6,537.73 ",
            " Min Reimb ": " $1,295.40 ",
            " Max Reimb ": " $4,576.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR EYELID DEFECT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "67904",
            " Charge Amount ": " $7,217.44 ",
            " Min Reimb ": " $1,295.40 ",
            " Max Reimb ": " $5,052.21 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR EYELID DEFECT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "67908",
            " Charge Amount ": " $7,550.51 ",
            " Min Reimb ": " $1,295.40 ",
            " Max Reimb ": " $5,285.36 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR EYELID DEFECT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "67917",
            " Charge Amount ": " $5,303.31 ",
            " Min Reimb ": " $1,295.40 ",
            " Max Reimb ": " $3,712.32 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR EYELID DEFECT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "67924",
            " Charge Amount ": " $5,889.20 ",
            " Min Reimb ": " $1,295.40 ",
            " Max Reimb ": " $4,122.44 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISION OF EYELID",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "67966",
            " Charge Amount ": " $6,963.54 ",
            " Min Reimb ": " $1,295.40 ",
            " Max Reimb ": " $4,874.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE EYELID LINING LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "68110",
            " Charge Amount ": " $16,919.25 ",
            " Min Reimb ": " $837.60 ",
            " Max Reimb ": " $11,843.48 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PROBE NASOLACRIMAL DUCT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "68811",
            " Charge Amount ": " $4,263.11 ",
            " Min Reimb ": " $638.31 ",
            " Max Reimb ": " $2,984.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "PROBE NL DUCT W/BALLOON",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "68816",
            " Charge Amount ": " $6,328.78 ",
            " Min Reimb ": " $638.31 ",
            " Max Reimb ": " $4,430.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "DRAIN EXTERNAL EAR LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "69000",
            " Charge Amount ": " $3,860.28 ",
            " Min Reimb ": " $166.12 ",
            " Max Reimb ": " $2,702.19 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE EXTERNAL EAR PARTIAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "69110",
            " Charge Amount ": " $6,123.17 ",
            " Min Reimb ": " $1,113.49 ",
            " Max Reimb ": " $4,286.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE EAR CANAL LESION(S)",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "69145",
            " Charge Amount ": " $4,260.32 ",
            " Min Reimb ": " $1,287.56 ",
            " Max Reimb ": " $2,982.22 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CLEAR OUTER EAR CANAL",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "69205",
            " Charge Amount ": " $5,935.00 ",
            " Min Reimb ": " $1,260.53 ",
            " Max Reimb ": " $4,154.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE IMPACTED EAR WAX UNI",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "69210",
            " Charge Amount ": " $4,111.59 ",
            " Min Reimb ": " $49.87 ",
            " Max Reimb ": " $2,878.11 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REVISE EXTERNAL EAR",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "69300",
            " Charge Amount ": " $12,596.49 ",
            " Min Reimb ": " $1,950.20 ",
            " Max Reimb ": " $8,817.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE VENTILATING TUBE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "69424",
            " Charge Amount ": " $3,742.80 ",
            " Min Reimb ": " $1,287.56 ",
            " Max Reimb ": " $2,619.96 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CREATE EARDRUM OPENING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "69436",
            " Charge Amount ": " $5,533.66 ",
            " Min Reimb ": " $1,211.96 ",
            " Max Reimb ": " $3,873.56 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REMOVE EAR LESION",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "69540",
            " Charge Amount ": " $5,042.85 ",
            " Min Reimb ": " $1,211.96 ",
            " Max Reimb ": " $3,529.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "REPAIR OF EARDRUM",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "69610",
            " Charge Amount ": " $4,998.80 ",
            " Min Reimb ": " $1,113.49 ",
            " Max Reimb ": " $3,499.16 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "ELECTROCARDIOGRAM TRACING",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "93005",
            " Charge Amount ": " $2,726.38 ",
            " Min Reimb ": " $43.57 ",
            " Max Reimb ": " $1,908.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "EXTREMITY STUDY",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "93971",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $97.63 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NRV CNDJ TEST 7-8 STUDIES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "95910",
            " Charge Amount ": " $4,854.91 ",
            " Min Reimb ": " $236.92 ",
            " Max Reimb ": " $3,398.43 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NRV CNDJ TEST 9-10 STUDIES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "95911",
            " Charge Amount ": " $6,131.63 ",
            " Min Reimb ": " $308.48 ",
            " Max Reimb ": " $4,292.14 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NRV CNDJ TEST 11-12 STUDIES",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "95912",
            " Charge Amount ": " $7,803.59 ",
            " Min Reimb ": " $308.48 ",
            " Max Reimb ": " $5,462.51 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INSERT ANT SEGMENT DRAIN INT",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "0191T",
            " Charge Amount ": " $20,529.23 ",
            " Min Reimb ": " $1,795.16 ",
            " Max Reimb ": " $14,370.46 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "NJX PLATELET PLASMA",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "0232T",
            " Charge Amount ": " $2,627.06 ",
            " Min Reimb ": " $242.09 ",
            " Max Reimb ": " $1,838.94 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTOSCOPY PROSTATIC IMP 1-3",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "C9739",
            " Charge Amount ": " $14,373.30 ",
            " Min Reimb ": " $2,095.91 ",
            " Max Reimb ": " $10,061.31 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CYSTO IMPL 4 OR MORE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "C9740",
            " Charge Amount ": " $23,266.92 ",
            " Min Reimb ": " $2,095.91 ",
            " Max Reimb ": " $16,286.85 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "CA SCREEN;FLEXI SIGMOIDSCOPE",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "G0104",
            " Charge Amount ": " $2,876.75 ",
            " Min Reimb ": " $528.90 ",
            " Max Reimb ": " $2,013.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COLORECTAL SCRN; HI RISK IND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "G0105",
            " Charge Amount ": " $3,974.62 ",
            " Min Reimb ": " $528.90 ",
            " Max Reimb ": " $2,782.23 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "COLON CA SCRN NOT HI RSK IND",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "G0121",
            " Charge Amount ": " $3,956.97 ",
            " Min Reimb ": " $528.90 ",
            " Max Reimb ": " $2,769.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "INJ FOR SACROILIAC JT ANESTH",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "G0260",
            " Charge Amount ": " $2,878.32 ",
            " Min Reimb ": " $426.37 ",
            " Max Reimb ": " $2,014.83 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "Various",
            "Item/Package": "Package",
            "Description": "I&D ABSCESS P-SPINE L/S/LS",
            "Location": "The Surgical Hospital at Southwoods; Southwoods Pain and Spine Center",
            "Revenue Code": "NULL",
            "CPT/HCPCS/DRG": "22015",
            " Charge Amount ": " $19,509.49 ",
            " Min Reimb ": " $4,733.76 ",
            " Max Reimb ": " $13,656.64 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "957830",
            "Item/Package": "Item",
            "Description": "Polysom <6 Yrs CPAP/BILVL",
            "Location": "Southwoods Sleep Center - Austintown",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95783",
            " Charge Amount ": " $5,568.00 ",
            " Min Reimb ": " $807.59 ",
            " Max Reimb ": " $3,897.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958030",
            "Item/Package": "Item",
            "Description": "ACTIGRAPHY TESTING",
            "Location": "Southwoods Sleep Center - Austintown",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95803",
            " Charge Amount ": " $945.00 ",
            " Min Reimb ": " $48.87 ",
            " Max Reimb ": " $661.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958050",
            "Item/Package": "Item",
            "Description": "MULTIPLE SLEEP LATENCY TEST",
            "Location": "Southwoods Sleep Center - Austintown",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95805",
            " Charge Amount ": " $4,640.00 ",
            " Min Reimb ": " $428.26 ",
            " Max Reimb ": " $3,248.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958060",
            "Item/Package": "Item",
            "Description": "SLEEP STUDY UNATTENDED SIMULT",
            "Location": "Southwoods Sleep Center - Austintown",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95806",
            " Charge Amount ": " $652.00 ",
            " Min Reimb ": " $122.52 ",
            " Max Reimb ": " $456.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958070",
            "Item/Package": "Item",
            "Description": "SLEEP STUDY",
            "Location": "Southwoods Sleep Center - Austintown",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95807",
            " Charge Amount ": " $4,640.00 ",
            " Min Reimb ": " $428.26 ",
            " Max Reimb ": " $3,248.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958080",
            "Item/Package": "Item",
            "Description": "POLYSOMNOGRAPHY 1-3",
            "Location": "Southwoods Sleep Center - Austintown",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95808",
            " Charge Amount ": " $4,640.00 ",
            " Min Reimb ": " $807.59 ",
            " Max Reimb ": " $3,248.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958100",
            "Item/Package": "Item",
            "Description": "POLYSOMNOGRAPHY 4 OR MORE",
            "Location": "Southwoods Sleep Center - Austintown",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95810",
            " Charge Amount ": " $4,640.00 ",
            " Min Reimb ": " $807.59 ",
            " Max Reimb ": " $3,248.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958110",
            "Item/Package": "Item",
            "Description": "POLYSOMNOGRAPHY SLEEP STAGING",
            "Location": "Southwoods Sleep Center - Austintown",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95811",
            " Charge Amount ": " $4,640.00 ",
            " Min Reimb ": " $807.59 ",
            " Max Reimb ": " $3,248.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "975820",
            "Item/Package": "Item",
            "Description": "Polysom<6 Yrs 4/>Paramtrs",
            "Location": "Southwoods Sleep Center - Austintown",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95782",
            " Charge Amount ": " $5,568.00 ",
            " Min Reimb ": " $807.59 ",
            " Max Reimb ": " $3,897.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "G03990",
            "Item/Package": "Item",
            "Description": "HOME SLP TEST HST W/ TYPE III",
            "Location": "Southwoods Sleep Center - Austintown",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "G0399",
            " Charge Amount ": " $652.00 ",
            " Min Reimb ": " $122.52 ",
            " Max Reimb ": " $456.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100103",
            "Item/Package": "Item",
            "Description": "Hospital Clinic Visit II",
            "Location": "Southwoods Sleep Center - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "G0463",
            " Charge Amount ": " $290.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $203.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "957830",
            "Item/Package": "Item",
            "Description": "Polysom <6 Yrs CPAP/BILVL",
            "Location": "Southwoods Sleep Center - Boardman",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95783",
            " Charge Amount ": " $5,568.00 ",
            " Min Reimb ": " $807.59 ",
            " Max Reimb ": " $3,897.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958030",
            "Item/Package": "Item",
            "Description": "ACTIGRAPHY TESTING",
            "Location": "Southwoods Sleep Center - Boardman",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95803",
            " Charge Amount ": " $945.00 ",
            " Min Reimb ": " $48.87 ",
            " Max Reimb ": " $661.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958050",
            "Item/Package": "Item",
            "Description": "MULTIPLE SLEEP LATENCY TEST",
            "Location": "Southwoods Sleep Center - Boardman",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95805",
            " Charge Amount ": " $4,640.00 ",
            " Min Reimb ": " $428.26 ",
            " Max Reimb ": " $3,248.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958060",
            "Item/Package": "Item",
            "Description": "SLEEP STUDY UNATTENDED SIMULT",
            "Location": "Southwoods Sleep Center - Boardman",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95806",
            " Charge Amount ": " $652.00 ",
            " Min Reimb ": " $122.52 ",
            " Max Reimb ": " $456.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958070",
            "Item/Package": "Item",
            "Description": "SLEEP STUDY",
            "Location": "Southwoods Sleep Center - Boardman",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95807",
            " Charge Amount ": " $4,640.00 ",
            " Min Reimb ": " $428.26 ",
            " Max Reimb ": " $3,248.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958080",
            "Item/Package": "Item",
            "Description": "POLYSOMNOGRAPHY 1-3",
            "Location": "Southwoods Sleep Center - Boardman",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95808",
            " Charge Amount ": " $4,640.00 ",
            " Min Reimb ": " $807.59 ",
            " Max Reimb ": " $3,248.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958100",
            "Item/Package": "Item",
            "Description": "POLYSOMNOGRAPHY 4 OR MORE",
            "Location": "Southwoods Sleep Center - Boardman",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95810",
            " Charge Amount ": " $4,640.00 ",
            " Min Reimb ": " $807.59 ",
            " Max Reimb ": " $3,248.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "958110",
            "Item/Package": "Item",
            "Description": "POLYSOMNOGRAPHY SLEEP STAGING",
            "Location": "Southwoods Sleep Center - Boardman",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95811",
            " Charge Amount ": " $4,640.00 ",
            " Min Reimb ": " $807.59 ",
            " Max Reimb ": " $3,248.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "975820",
            "Item/Package": "Item",
            "Description": "Polysom<6 Yrs 4/>Paramtrs",
            "Location": "Southwoods Sleep Center - Boardman",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "95782",
            " Charge Amount ": " $5,568.00 ",
            " Min Reimb ": " $807.59 ",
            " Max Reimb ": " $3,897.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90016",
            "Item/Package": "Item",
            "Description": "ALBUMIN HUMAN 25 GM/100 ML",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $516.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $361.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90099",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE 0.5% 5 MG/ML 50ML",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90105",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE/PF 0.25% 30 ML VIA",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "250",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $16.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "847",
            "Item/Package": "Item",
            "Description": "RAD NEEDLE LOC HAWKINS 5.0CM",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $262.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $183.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "2512",
            "Item/Package": "Item",
            "Description": "CATHETER HYSTEROSALPINGOGRAM",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $195.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $136.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "5023",
            "Item/Package": "Item",
            "Description": "LAB ISTAT CHEM 8",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7492",
            "Item/Package": "Item",
            "Description": "RAD CANN JABCZENSKI DGRAM 30G",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $244.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $170.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7514",
            "Item/Package": "Item",
            "Description": "RAD BX TITAN SITE MARKER 15G",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $525.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $367.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7753",
            "Item/Package": "Item",
            "Description": "RAD NEEDLE FRANSEEN BX 22GX9CM",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $125.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $87.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7798",
            "Item/Package": "Item",
            "Description": "RAD BX SITE IDENT EVIVA 13CM",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $525.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $367.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7800",
            "Item/Package": "Item",
            "Description": "RAD BX DEV BREAST EVIVA 9G",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $1,588.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,111.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7801",
            "Item/Package": "Item",
            "Description": "RAD NEEDLE GUIDE EVIVA 12G",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $69.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $48.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7924",
            "Item/Package": "Item",
            "Description": "RAD NEEDL FRANSEEN BX 20GX9CM",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $130.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $91.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7926",
            "Item/Package": "Item",
            "Description": "RAD NEEDL FRANSEEN BX 22GX15CM",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $130.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $91.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7933",
            "Item/Package": "Item",
            "Description": "RAD CONTAINER EVAC 1000ML",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $33.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8343",
            "Item/Package": "Item",
            "Description": "RAD NEEDL YUEH CENTESIS CATH4",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "8755",
            "Item/Package": "Item",
            "Description": "RAD NEEDLE BX 12GX10CM MQ1210",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9711",
            "Item/Package": "Item",
            "Description": "RAD DRAIN CATH SKATER 6X20FR",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $582.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $407.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10696",
            "Item/Package": "Item",
            "Description": "RAD BOTTLE PLASTIC EVA W/DRN",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $111.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $77.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "10697",
            "Item/Package": "Item",
            "Description": "RAD BOTTLE PLASTIC EVACUATION",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $111.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $77.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "M000000002",
            "Item/Package": "Item",
            "Description": "HSG TRAY",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $152.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "810250",
            "Item/Package": "Item",
            "Description": "URINE PREGNANCY",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "81025",
            " Charge Amount ": " $46.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $32.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "820420",
            "Item/Package": "Item",
            "Description": "ASSAY URINE ALBUMN",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82042",
            " Charge Amount ": " $35.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "821500",
            "Item/Package": "Item",
            "Description": "AMYLASE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82150",
            " Charge Amount ": " $47.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $32.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "825650",
            "Item/Package": "Item",
            "Description": "CREATININE BLOOD",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82565",
            " Charge Amount ": " $51.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $35.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "836150",
            "Item/Package": "Item",
            "Description": "LACTATE LD LDH ENZYME",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "83615",
            " Charge Amount ": " $46.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $32.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "841570",
            "Item/Package": "Item",
            "Description": "TOTAL PROTEIN OTHER SPECIMEN",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84157",
            " Charge Amount ": " $22.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "845200",
            "Item/Package": "Item",
            "Description": "BUN",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84520",
            " Charge Amount ": " $35.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "870770",
            "Item/Package": "Item",
            "Description": "AEROBIC ID",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87077",
            " Charge Amount ": " $62.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "871860",
            "Item/Package": "Item",
            "Description": "ANTIBIOTIC SENSITIVITY MIC",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87186",
            " Charge Amount ": " $56.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $39.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "825650CT",
            "Item/Package": "Item",
            "Description": "CREATININE BLOOD",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82565",
            " Charge Amount ": " $49.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $34.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "825650MR",
            "Item/Package": "Item",
            "Description": "CREATININE BLOOD",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82565",
            " Charge Amount ": " $49.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $34.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "825650XR",
            "Item/Package": "Item",
            "Description": "CREATININE BLOOD",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "82565",
            " Charge Amount ": " $49.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $34.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "845200CT",
            "Item/Package": "Item",
            "Description": "BUN",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84520",
            " Charge Amount ": " $33.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "845200XR",
            "Item/Package": "Item",
            "Description": "BUN",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "84520",
            " Charge Amount ": " $33.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "870700CT",
            "Item/Package": "Item",
            "Description": "CULTURE OTHER SOURCE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87070",
            " Charge Amount ": " $62.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "870700US",
            "Item/Package": "Item",
            "Description": "CULTURE OTHER SOURCE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87070",
            " Charge Amount ": " $62.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "870700XR",
            "Item/Package": "Item",
            "Description": "CULTURE OTHER SOURCE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87070",
            " Charge Amount ": " $62.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $43.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "870750CT",
            "Item/Package": "Item",
            "Description": "AEROBIC ANAEROBIC",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87075",
            " Charge Amount ": " $66.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "870750US",
            "Item/Package": "Item",
            "Description": "AEROBIC ANAEROBIC",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87075",
            " Charge Amount ": " $66.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "870750XR",
            "Item/Package": "Item",
            "Description": "AEROBIC ANAEROBIC",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87075",
            " Charge Amount ": " $66.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "872050CT",
            "Item/Package": "Item",
            "Description": "SMEAR PRIMARY SOURCE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87205",
            " Charge Amount ": " $34.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "872050US",
            "Item/Package": "Item",
            "Description": "SMEAR PRIMARY SOURCE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87205",
            " Charge Amount ": " $34.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "872050XR",
            "Item/Package": "Item",
            "Description": "SMEAR PRIMARY SOURCE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "87205",
            " Charge Amount ": " $34.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "890510CT",
            "Item/Package": "Item",
            "Description": "BODY FLUID CELL COUNT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "89051",
            " Charge Amount ": " $34.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "890510US",
            "Item/Package": "Item",
            "Description": "BODY FLUID CELL COUNT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "89051",
            " Charge Amount ": " $34.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "890510XR",
            "Item/Package": "Item",
            "Description": "BODY FLUID CELL COUNT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "89051",
            " Charge Amount ": " $34.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881040",
            "Item/Package": "Item",
            "Description": "CYTOPATH FL NONGYN SMEARS",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88104",
            " Charge Amount ": " $278.00 ",
            " Min Reimb ": " $29.37 ",
            " Max Reimb ": " $194.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881080",
            "Item/Package": "Item",
            "Description": "CP CONCENTR TECH SMEAR",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88108",
            " Charge Amount ": " $398.00 ",
            " Min Reimb ": " $29.37 ",
            " Max Reimb ": " $278.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881730",
            "Item/Package": "Item",
            "Description": "INTERPRETATION OF SMEAR",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88173",
            " Charge Amount ": " $231.00 ",
            " Min Reimb ": " $43.69 ",
            " Max Reimb ": " $161.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881870",
            "Item/Package": "Item",
            "Description": "FLW CYTOMET INTERP 2-8 MARKER",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88187",
            " Charge Amount ": " $48.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $33.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881890",
            "Item/Package": "Item",
            "Description": "FLW CYTOMET INTERP 16 & > MARK",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88189",
            " Charge Amount ": " $162.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $113.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883040",
            "Item/Package": "Item",
            "Description": "TISSUE EX BY PATHOLOGIST LVL 3",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88304",
            " Charge Amount ": " $146.00 ",
            " Min Reimb ": " $43.69 ",
            " Max Reimb ": " $102.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883050",
            "Item/Package": "Item",
            "Description": "TISSUE EX BY PATHOLOGIST LVL 4",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88305",
            " Charge Amount ": " $152.00 ",
            " Min Reimb ": " $43.69 ",
            " Max Reimb ": " $106.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883410",
            "Item/Package": "Item",
            "Description": "Each Add'l Antibody Stain Proc",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88341",
            " Charge Amount ": " $151.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $105.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883420",
            "Item/Package": "Item",
            "Description": "IMMUNOCYTOCHEMISTRY",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88342",
            " Charge Amount ": " $152.00 ",
            " Min Reimb ": " $73.85 ",
            " Max Reimb ": " $106.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883600",
            "Item/Package": "Item",
            "Description": "TUMOR IMMUNOHISTOC/MANUAL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88360",
            " Charge Amount ": " $152.00 ",
            " Min Reimb ": " $130.96 ",
            " Max Reimb ": " $106.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881120CT",
            "Item/Package": "Item",
            "Description": "CYTOPATH CELL ENHANCE TECH",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88112",
            " Charge Amount ": " $146.00 ",
            " Min Reimb ": " $43.69 ",
            " Max Reimb ": " $102.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881120US",
            "Item/Package": "Item",
            "Description": "CYTOPATH CELL ENHANCE TECH",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88112",
            " Charge Amount ": " $146.00 ",
            " Min Reimb ": " $43.69 ",
            " Max Reimb ": " $102.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881730US",
            "Item/Package": "Item",
            "Description": "INTERPRETATION OF SMEAR",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88173",
            " Charge Amount ": " $231.00 ",
            " Min Reimb ": " $43.69 ",
            " Max Reimb ": " $161.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881840US",
            "Item/Package": "Item",
            "Description": "FLOW CYTOMETRY TC 1ST MARKER",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88184",
            " Charge Amount ": " $70.00 ",
            " Min Reimb ": " $73.85 ",
            " Max Reimb ": " $49.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881850US",
            "Item/Package": "Item",
            "Description": "FLOW CYTOMETRY EA ADD'L MARKER",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88185",
            " Charge Amount ": " $70.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $49.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "881880US",
            "Item/Package": "Item",
            "Description": "9 TO 15 MARKERS",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88188",
            " Charge Amount ": " $153.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $107.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883050CT",
            "Item/Package": "Item",
            "Description": "TISSUE EX BY PATHOLOGIST LVL 4",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88305",
            " Charge Amount ": " $146.00 ",
            " Min Reimb ": " $43.69 ",
            " Max Reimb ": " $102.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883050MM",
            "Item/Package": "Item",
            "Description": "TISSUE EX BY PATHOLOGIST LVL 4",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88305",
            " Charge Amount ": " $146.00 ",
            " Min Reimb ": " $43.69 ",
            " Max Reimb ": " $102.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883050NM",
            "Item/Package": "Item",
            "Description": "TISSUE EX BY PATHOLOGIST LVL 4",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88305",
            " Charge Amount ": " $146.00 ",
            " Min Reimb ": " $43.69 ",
            " Max Reimb ": " $102.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883050US",
            "Item/Package": "Item",
            "Description": "TISSUE EX BY PATHOLOGIST LVL 4",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88305",
            " Charge Amount ": " $146.00 ",
            " Min Reimb ": " $43.69 ",
            " Max Reimb ": " $102.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883050XR",
            "Item/Package": "Item",
            "Description": "TISSUE EX BY PATHOLOGIST LVL 4",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88305",
            " Charge Amount ": " $146.00 ",
            " Min Reimb ": " $43.69 ",
            " Max Reimb ": " $102.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883120US",
            "Item/Package": "Item",
            "Description": "SPECIAL STAINS",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88312",
            " Charge Amount ": " $67.00 ",
            " Min Reimb ": " $43.69 ",
            " Max Reimb ": " $46.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883420MM",
            "Item/Package": "Item",
            "Description": "IMMUNOCYTOCHEMISTRY",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88342",
            " Charge Amount ": " $146.00 ",
            " Min Reimb ": " $73.85 ",
            " Max Reimb ": " $102.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883420US",
            "Item/Package": "Item",
            "Description": "IMMUNOCYTOCHEMISTRY",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88342",
            " Charge Amount ": " $146.00 ",
            " Min Reimb ": " $73.85 ",
            " Max Reimb ": " $102.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883600MM",
            "Item/Package": "Item",
            "Description": "TUMOR IMMUNOHISTOCHEM/MANUAL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88360",
            " Charge Amount ": " $146.00 ",
            " Min Reimb ": " $130.96 ",
            " Max Reimb ": " $102.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "883600US",
            "Item/Package": "Item",
            "Description": "TUMOR IMMUNOHISTOCHEM/MANUAL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "310",
            "CPT/HCPCS/DRG": "88360",
            " Charge Amount ": " $146.00 ",
            " Min Reimb ": " $130.96 ",
            " Max Reimb ": " $102.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "270930",
            "Item/Package": "Item",
            "Description": "HIP ARTHROGRAPHY INJ WO ANES",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "27093",
            " Charge Amount ": " $1,116.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $781.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "365980",
            "Item/Package": "Item",
            "Description": "CONT INJ(S)RAD EVAL EX CEN VEN",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "36598",
            " Charge Amount ": " $728.00 ",
            " Min Reimb ": " $152.03 ",
            " Max Reimb ": " $509.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "622840",
            "Item/Package": "Item",
            "Description": "INJ FOR MYELOGRAM",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "62284",
            " Charge Amount ": " $2,087.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,460.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701100",
            "Item/Package": "Item",
            "Description": "XR MANDIBLE COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70110",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701500",
            "Item/Package": "Item",
            "Description": "XR FACIAL BONES > 3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70150",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701600",
            "Item/Package": "Item",
            "Description": "XR NASAL BONE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70160",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702000",
            "Item/Package": "Item",
            "Description": "XR ORBIT COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70200",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702100",
            "Item/Package": "Item",
            "Description": "XR SINUS WATERS VIEW",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70210",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702200",
            "Item/Package": "Item",
            "Description": "XR SINUSES",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70220",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702500",
            "Item/Package": "Item",
            "Description": "XR SKULL < 4 VIEWS",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70250",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702600",
            "Item/Package": "Item",
            "Description": "XR SKULL COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70260",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "703300",
            "Item/Package": "Item",
            "Description": "XR JAW JOINTS",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70330",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "703600",
            "Item/Package": "Item",
            "Description": "XR SOFT TISSUE NECK",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70360",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720200",
            "Item/Package": "Item",
            "Description": "XR LUMBAR SPINE 1V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720400",
            "Item/Package": "Item",
            "Description": "XR SPINE CERVICAL 3 V/L",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72040",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720500",
            "Item/Package": "Item",
            "Description": "XR SPINE CERVICAL 4 OR 5 VIEWS",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72050",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720520",
            "Item/Package": "Item",
            "Description": "XR SPINE CERVICAL W FLEX EXTEN",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72052",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720700",
            "Item/Package": "Item",
            "Description": "XR THORACIC SPINE 2 V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72070",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720720",
            "Item/Package": "Item",
            "Description": "XR THORACIC SPINE 3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72072",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720810",
            "Item/Package": "Item",
            "Description": "XR ENTIRE SPINE 1V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72081",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721000",
            "Item/Package": "Item",
            "Description": "XR LUMBAR SPINE  2-3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721100",
            "Item/Package": "Item",
            "Description": "XR LOWER SPINE MIN 4V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72110",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721140",
            "Item/Package": "Item",
            "Description": "XR LUMBAR SPINE 6V W BENDING",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72114",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721200",
            "Item/Package": "Item",
            "Description": "XR LOWER SPINE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72120",
            " Charge Amount ": " $572.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $400.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721700",
            "Item/Package": "Item",
            "Description": "XR PELVIS AP VIEW",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72170",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721900",
            "Item/Package": "Item",
            "Description": "XR PELVIS MIN 3 V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72190",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "722000",
            "Item/Package": "Item",
            "Description": "XR SACROILIAC JOINT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72200",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "722020",
            "Item/Package": "Item",
            "Description": "XR SACROILIAC JOINTS",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72202",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "722200",
            "Item/Package": "Item",
            "Description": "XR SACRUM COCYX",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72220",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730002",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730003",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730004",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE BI",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730102",
            "Item/Package": "Item",
            "Description": "XR SCAPULA LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730103",
            "Item/Package": "Item",
            "Description": "XR SCAPULA RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730202",
            "Item/Package": "Item",
            "Description": "XR SHOULDER LT 1V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730300",
            "Item/Package": "Item",
            "Description": "XR SHOULDER COMPLETE BL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73030",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730302",
            "Item/Package": "Item",
            "Description": "XR SHOULDER LT COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73030",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730303",
            "Item/Package": "Item",
            "Description": "XR SHOULDER RT COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73030",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730602",
            "Item/Package": "Item",
            "Description": "XR HUMERUS LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730603",
            "Item/Package": "Item",
            "Description": "XR HUMERUS RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730702",
            "Item/Package": "Item",
            "Description": "XR ELBOW LT LIMITED",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73070",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730703",
            "Item/Package": "Item",
            "Description": "XR ELBOW RT LIMITED",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73070",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730802",
            "Item/Package": "Item",
            "Description": "XR ELBOW LT COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730803",
            "Item/Package": "Item",
            "Description": "XR ELBOW RT COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730804",
            "Item/Package": "Item",
            "Description": "XR ELBOW BI COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730902",
            "Item/Package": "Item",
            "Description": "XR FOREARM LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730903",
            "Item/Package": "Item",
            "Description": "XR FOREARM RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731002",
            "Item/Package": "Item",
            "Description": "XR WRIST LT LIMITED",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731003",
            "Item/Package": "Item",
            "Description": "XR WRIST RT LIMITED",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731004",
            "Item/Package": "Item",
            "Description": "XR WRIST BL LIMITED",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731100",
            "Item/Package": "Item",
            "Description": "XR WRIST BL COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73110",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731102",
            "Item/Package": "Item",
            "Description": "XR WRIST LT COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73110",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731103",
            "Item/Package": "Item",
            "Description": "XR WRIST RT COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73110",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731202",
            "Item/Package": "Item",
            "Description": "XR HAND LT 2V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731203",
            "Item/Package": "Item",
            "Description": "XR HAND RT 2V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731204",
            "Item/Package": "Item",
            "Description": "XR HANS BL 2V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731300",
            "Item/Package": "Item",
            "Description": "XR HAND BL 3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73130",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731302",
            "Item/Package": "Item",
            "Description": "XR HAND LT 3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73130",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731303",
            "Item/Package": "Item",
            "Description": "XR HAND RT 3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73130",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731402",
            "Item/Package": "Item",
            "Description": "XR FINGER LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73140",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731403",
            "Item/Package": "Item",
            "Description": "XR FINGER RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73140",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735010",
            "Item/Package": "Item",
            "Description": "XR HIP UNI 1V RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73501",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735012",
            "Item/Package": "Item",
            "Description": "XR HIP UNI 1V LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73501",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735022",
            "Item/Package": "Item",
            "Description": "XR HIP UNI/PELVIS 2-3V RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73502",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735023",
            "Item/Package": "Item",
            "Description": "XR HIP UNI/PELVIS 2-3V LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73502",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735210",
            "Item/Package": "Item",
            "Description": "XR Hips BL W/PELVIS 2V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73521",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735520",
            "Item/Package": "Item",
            "Description": "XR FEMUR 2/> BL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73552",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735522",
            "Item/Package": "Item",
            "Description": "XR FEMUR 2/> RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73552",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735523",
            "Item/Package": "Item",
            "Description": "XR FEMUR 2/>LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73552",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735602",
            "Item/Package": "Item",
            "Description": "XR KNEE LT LIMITED",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735603",
            "Item/Package": "Item",
            "Description": "XR KNEE RT LIMITED",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735604",
            "Item/Package": "Item",
            "Description": "XR KNEE BL LIMITED",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735622",
            "Item/Package": "Item",
            "Description": "XR KNEE LT 3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735623",
            "Item/Package": "Item",
            "Description": "XR KNEE RT 3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735624",
            "Item/Package": "Item",
            "Description": "XR KNEE BL 3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735640",
            "Item/Package": "Item",
            "Description": "XR KNEE BL 4V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73564",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735642",
            "Item/Package": "Item",
            "Description": "XR KNEE LT 4V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73564",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735643",
            "Item/Package": "Item",
            "Description": "XR KNEE RT 4V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73564",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735650",
            "Item/Package": "Item",
            "Description": "XR KNEE STANDING AP BL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73565",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735902",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735903",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735904",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA BL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736002",
            "Item/Package": "Item",
            "Description": "XR ANKLE LT LIMITED",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736003",
            "Item/Package": "Item",
            "Description": "XR ANKLE RT LIMITED",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736100",
            "Item/Package": "Item",
            "Description": "XR ANKLE BL COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73610",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736102",
            "Item/Package": "Item",
            "Description": "XR ANKLE LT COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73610",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736103",
            "Item/Package": "Item",
            "Description": "XR ANKLE RT COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73610",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736202",
            "Item/Package": "Item",
            "Description": "XR FOOT LT 2V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736203",
            "Item/Package": "Item",
            "Description": "XR FOOT RT 2V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736302",
            "Item/Package": "Item",
            "Description": "XR FOOT LT 3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736303",
            "Item/Package": "Item",
            "Description": "XR FOOT RT 3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736304",
            "Item/Package": "Item",
            "Description": "XR FOOT BL 3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736502",
            "Item/Package": "Item",
            "Description": "XR CALCANEUS LT 2V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736503",
            "Item/Package": "Item",
            "Description": "XR CALCANEUS RT 2V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736504",
            "Item/Package": "Item",
            "Description": "XR CALCANEUS BI 2V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736602",
            "Item/Package": "Item",
            "Description": "XR TOES LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73660",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736603",
            "Item/Package": "Item",
            "Description": "XR TOES RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73660",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740180",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN 1V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74018",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740190",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN 2V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74019",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740220",
            "Item/Package": "Item",
            "Description": "XR SERIES ABDOMEN",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74022",
            " Charge Amount ": " $572.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $400.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "742200",
            "Item/Package": "Item",
            "Description": "FL BARIUM SWALLOW",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74220",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "742410",
            "Item/Package": "Item",
            "Description": "FL UPPER GI SERIES",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74240",
            " Charge Amount ": " $1,149.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $804.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "742460",
            "Item/Package": "Item",
            "Description": "XR UPPER GI TRACT W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74246",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "742470",
            "Item/Package": "Item",
            "Description": "FL UPPER GI W AIR",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74246",
            " Charge Amount ": " $1,150.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $805.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "742490",
            "Item/Package": "Item",
            "Description": "FL BARIUM SWSALLOW W SBFT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74246",
            " Charge Amount ": " $1,150.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $805.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "742500",
            "Item/Package": "Item",
            "Description": "XR SMALL BOWEL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74250",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "742700",
            "Item/Package": "Item",
            "Description": "FL ENEMA W GASTROGRAFIN",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74270",
            " Charge Amount ": " $1,150.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $805.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "742800",
            "Item/Package": "Item",
            "Description": "FL BARIUM ENEMA W AIR CONTRAST",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74280",
            " Charge Amount ": " $1,150.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $805.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "744000",
            "Item/Package": "Item",
            "Description": "URO INTRA W/WO KUB/TOMO",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74400",
            " Charge Amount ": " $854.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $597.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "744300",
            "Item/Package": "Item",
            "Description": "CYSTOGRAPHY 3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74430",
            " Charge Amount ": " $766.00 ",
            " Min Reimb ": " $201.67 ",
            " Max Reimb ": " $536.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "747400",
            "Item/Package": "Item",
            "Description": "FL HYSTEROSALPINGOGRAPHY",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74740",
            " Charge Amount ": " $783.00 ",
            " Min Reimb ": " $201.67 ",
            " Max Reimb ": " $548.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "760000",
            "Item/Package": "Item",
            "Description": "FL FLUOROSCOPY <1hr",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "76000",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $201.67 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770020",
            "Item/Package": "Item",
            "Description": "FL GUIDED INJECTION",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "77002",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770023",
            "Item/Package": "Item",
            "Description": "FL GUIDED ASPIRATION JOINT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "77002",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770030",
            "Item/Package": "Item",
            "Description": "FL SPINE INJECT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "77003",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770730",
            "Item/Package": "Item",
            "Description": "XR BONE LENGTH",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "77073",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770750",
            "Item/Package": "Item",
            "Description": "XR SKELETAL COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "77075",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770800",
            "Item/Package": "Item",
            "Description": "XR DEXA AXIAL SKELETON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "77080",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $79.46 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770810",
            "Item/Package": "Item",
            "Description": "XR DEXA APPENDICULAR SKELETON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "77081",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "I000000008",
            "Item/Package": "Item",
            "Description": "XR SML INTEST STDY",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74248",
            " Charge Amount ": " $769.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $538.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710450",
            "Item/Package": "Item",
            "Description": "XR CHEST 1V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71045",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710460",
            "Item/Package": "Item",
            "Description": "XR CHEST 2V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71046",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710470",
            "Item/Package": "Item",
            "Description": "XR CHEST 3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71047",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711010",
            "Item/Package": "Item",
            "Description": "XR RIBS CHEST",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71101",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711100",
            "Item/Package": "Item",
            "Description": "XR RIBS BL 3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71110",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711114",
            "Item/Package": "Item",
            "Description": "XR RIBS BI",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71111",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711200",
            "Item/Package": "Item",
            "Description": "XR STERNUM",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71120",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711300",
            "Item/Package": "Item",
            "Description": "XR BREASTBONE 3V",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71130",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "I000000010",
            "Item/Package": "Item",
            "Description": "XR RIBS LT W CHEST",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71101",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "I000000011",
            "Item/Package": "Item",
            "Description": "XR RIBS RT W CHEST",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71101",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "780130",
            "Item/Package": "Item",
            "Description": "NM THYROID IMAGE W/BLOOD FLOW",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78013",
            " Charge Amount ": " $730.00 ",
            " Min Reimb ": " $250.12 ",
            " Max Reimb ": " $510.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "780140",
            "Item/Package": "Item",
            "Description": "NM THYROID W UPTAKE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78014",
            " Charge Amount ": " $1,138.00 ",
            " Min Reimb ": " $250.12 ",
            " Max Reimb ": " $796.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "780700",
            "Item/Package": "Item",
            "Description": "NM PARATHYROID",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78070",
            " Charge Amount ": " $1,822.00 ",
            " Min Reimb ": " $331.10 ",
            " Max Reimb ": " $1,275.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "781950",
            "Item/Package": "Item",
            "Description": "NM LYMPHATICS /LYMPH NODES",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78195",
            " Charge Amount ": " $2,236.00 ",
            " Min Reimb ": " $429.68 ",
            " Max Reimb ": " $1,565.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "782260",
            "Item/Package": "Item",
            "Description": "NM CHOLESCINTIGRAPHY",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78226",
            " Charge Amount ": " $2,101.00 ",
            " Min Reimb ": " $250.12 ",
            " Max Reimb ": " $1,470.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "782270",
            "Item/Package": "Item",
            "Description": "NM HEPATOBIL SYST IMAG W/DRUG",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78227",
            " Charge Amount ": " $2,111.00 ",
            " Min Reimb ": " $250.12 ",
            " Max Reimb ": " $1,477.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "782640",
            "Item/Package": "Item",
            "Description": "NM GASTRIC EMPTYING STUDY",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78264",
            " Charge Amount ": " $2,039.00 ",
            " Min Reimb ": " $250.12 ",
            " Max Reimb ": " $1,427.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "782780",
            "Item/Package": "Item",
            "Description": "NM GI BLEEDING",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78278",
            " Charge Amount ": " $1,934.00 ",
            " Min Reimb ": " $331.10 ",
            " Max Reimb ": " $1,353.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "783000",
            "Item/Package": "Item",
            "Description": "NM BONE IMAGING LIMITED",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78300",
            " Charge Amount ": " $1,430.00 ",
            " Min Reimb ": " $250.12 ",
            " Max Reimb ": " $1,000.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "783060",
            "Item/Package": "Item",
            "Description": "NM BONE IMAG WHOLE BODY",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78306",
            " Charge Amount ": " $2,179.00 ",
            " Min Reimb ": " $250.12 ",
            " Max Reimb ": " $1,525.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "783150",
            "Item/Package": "Item",
            "Description": "NM BONE 3 PHASE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78315",
            " Charge Amount ": " $2,357.00 ",
            " Min Reimb ": " $250.12 ",
            " Max Reimb ": " $1,649.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "783200",
            "Item/Package": "Item",
            "Description": "NM BONE IMAGING (3D)",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78803",
            " Charge Amount ": " $3,567.00 ",
            " Min Reimb ": " $571.20 ",
            " Max Reimb ": " $2,496.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "784720",
            "Item/Package": "Item",
            "Description": "NM MUGA SGL W WM & EF",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78472",
            " Charge Amount ": " $2,268.00 ",
            " Min Reimb ": " $250.12 ",
            " Max Reimb ": " $1,587.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "787070",
            "Item/Package": "Item",
            "Description": "NM RENAL FLOW AND FUNCTION",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78707",
            " Charge Amount ": " $2,167.00 ",
            " Min Reimb ": " $250.12 ",
            " Max Reimb ": " $1,516.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "787080",
            "Item/Package": "Item",
            "Description": "NM RENAL FLOW W PHARM INT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78708",
            " Charge Amount ": " $2,943.00 ",
            " Min Reimb ": " $250.12 ",
            " Max Reimb ": " $2,060.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9528",
            "Item/Package": "Item",
            "Description": "IODINE CAPSULES <1 MICROCUR",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "343",
            "CPT/HCPCS/DRG": "A9528",
            " Charge Amount ": " $189.74 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $132.82 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90753",
            "Item/Package": "Item",
            "Description": "TC99M SESTAMIBI = < 20 MCI",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "343",
            "CPT/HCPCS/DRG": "A9500",
            " Charge Amount ": " $556.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $389.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90754",
            "Item/Package": "Item",
            "Description": "TC99M MEDRONATE =< 30 MCI",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "343",
            "CPT/HCPCS/DRG": "A9503",
            " Charge Amount ": " $111.30 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $77.91 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90755",
            "Item/Package": "Item",
            "Description": "TC99M PERTECHNETATE PER 1 MCI",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "343",
            "CPT/HCPCS/DRG": "A9512",
            " Charge Amount ": " $6.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90758",
            "Item/Package": "Item",
            "Description": "TC99M MEBROFENIN =< 15 MCI",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "343",
            "CPT/HCPCS/DRG": "A9537",
            " Charge Amount ": " $249.10 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $174.37 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90760",
            "Item/Package": "Item",
            "Description": "TC99M SULFUR COLLOID =< 20 MCI",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "343",
            "CPT/HCPCS/DRG": "A9541",
            " Charge Amount ": " $233.20 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $163.24 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90761",
            "Item/Package": "Item",
            "Description": "F18 FDG =< 45 MCI",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "343",
            "CPT/HCPCS/DRG": "A9552",
            " Charge Amount ": " $1,663.14 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,164.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90763",
            "Item/Package": "Item",
            "Description": "TC99M MERTIATIDE =< 15 MCI",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "343",
            "CPT/HCPCS/DRG": "A9562",
            " Charge Amount ": " $1,060.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $742.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90852",
            "Item/Package": "Item",
            "Description": "TECHNITEUM 99 RBC",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "343",
            "CPT/HCPCS/DRG": "A9560",
            " Charge Amount ": " $4,403.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3,082.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704920",
            "Item/Package": "Item",
            "Description": "CT SOFT TISSUE NECK WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "70492",
            " Charge Amount ": " $2,140.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $1,498.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704980",
            "Item/Package": "Item",
            "Description": "CT ANGIO NECK",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "70498",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721250",
            "Item/Package": "Item",
            "Description": "CT CERVICAL SPINE WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "72125",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721280",
            "Item/Package": "Item",
            "Description": "CT THORACIC SPINE WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "72128",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721290",
            "Item/Package": "Item",
            "Description": "CT THORACIC SPINE W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "72129",
            " Charge Amount ": " $1,581.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $1,106.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721310",
            "Item/Package": "Item",
            "Description": "CT LUMBAR SPINE WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "72131",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721320",
            "Item/Package": "Item",
            "Description": "CT LUMBAR SPINE W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "72132",
            " Charge Amount ": " $1,902.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $1,331.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721940",
            "Item/Package": "Item",
            "Description": "CT PELVIS W/WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "72194",
            " Charge Amount ": " $2,432.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $1,702.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741500",
            "Item/Package": "Item",
            "Description": "CT ABDOOMENT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "74150",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741760",
            "Item/Package": "Item",
            "Description": "CT ABDOMEN/PELVIS WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "74176",
            " Charge Amount ": " $1,190.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $833.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741780",
            "Item/Package": "Item",
            "Description": "CT ABDOMEN/PELVIS W/ WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "74178",
            " Charge Amount ": " $1,327.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $928.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "756350",
            "Item/Package": "Item",
            "Description": "CT ANGIO ABDOMEN/FEMORAL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "75635",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "763760",
            "Item/Package": "Item",
            "Description": "CT 3D RECONSTRUCTION",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "350",
            "CPT/HCPCS/DRG": "76376",
            " Charge Amount ": " $1,337.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $935.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704500",
            "Item/Package": "Item",
            "Description": "CT HEAD/BRAIN WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70450",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704700",
            "Item/Package": "Item",
            "Description": "CT HEAD/BRAIN WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70470",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704800",
            "Item/Package": "Item",
            "Description": "CT ORBITSEL MID/IN EAR W/O CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70480",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704820",
            "Item/Package": "Item",
            "Description": "CT ORBITSEL MID/IN EAR W/WO CO",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70482",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704860",
            "Item/Package": "Item",
            "Description": "CT FACIAL BONES WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70486",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704870",
            "Item/Package": "Item",
            "Description": "CT SINUS W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70487",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704880",
            "Item/Package": "Item",
            "Description": "CT SINUS WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70488",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704900",
            "Item/Package": "Item",
            "Description": "CT SOFT TISSUE NECK WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70490",
            " Charge Amount ": " $1,585.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $1,109.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704910",
            "Item/Package": "Item",
            "Description": "CT SOFT TISSUE NECK W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70491",
            " Charge Amount ": " $1,943.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $1,360.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704960",
            "Item/Package": "Item",
            "Description": "CT ANGIO HEAD",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "351",
            "CPT/HCPCS/DRG": "70496",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100094",
            "Item/Package": "Item",
            "Description": "LDCT LUNG CA SCREEN",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "71271",
            " Charge Amount ": " $2,285.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $1,599.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "704826",
            "Item/Package": "Item",
            "Description": "CT INTERNAL AUDIOTRY CANALS BI",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "70482",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "712500",
            "Item/Package": "Item",
            "Description": "CT CHEST WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "71250",
            " Charge Amount ": " $1,586.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $1,110.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "712600",
            "Item/Package": "Item",
            "Description": "CT CHEST W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "71260",
            " Charge Amount ": " $1,945.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $1,361.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "712750",
            "Item/Package": "Item",
            "Description": "CTA CHEST",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "71275",
            " Charge Amount ": " $2,603.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $1,822.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721260",
            "Item/Package": "Item",
            "Description": "CT CERVICAL SPINE WITH CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "72126",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721920",
            "Item/Package": "Item",
            "Description": "CT PELVIS WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "72192",
            " Charge Amount ": " $1,586.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $1,110.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721930",
            "Item/Package": "Item",
            "Description": "CT PELVIS W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "72193",
            " Charge Amount ": " $1,943.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $1,360.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732002",
            "Item/Package": "Item",
            "Description": "CT ELBOW LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73200",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732003",
            "Item/Package": "Item",
            "Description": "CT ELBOW RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73200",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732004",
            "Item/Package": "Item",
            "Description": "CT WRIST LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73200",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732005",
            "Item/Package": "Item",
            "Description": "CT WRIST RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73200",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732008",
            "Item/Package": "Item",
            "Description": "CT HAND LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73200",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732009",
            "Item/Package": "Item",
            "Description": "CT HAND RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73200",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732068",
            "Item/Package": "Item",
            "Description": "CT ANGIO UE LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73206",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737000",
            "Item/Package": "Item",
            "Description": "CT LOWER LEG WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73700",
            " Charge Amount ": " $2,961.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,072.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737002",
            "Item/Package": "Item",
            "Description": "CT ANKLE LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73700",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737003",
            "Item/Package": "Item",
            "Description": "CT ANKLE RT W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73700",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737005",
            "Item/Package": "Item",
            "Description": "CT CLACANEUS RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73700",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737007",
            "Item/Package": "Item",
            "Description": "CT FEMUR RT W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73700",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737010",
            "Item/Package": "Item",
            "Description": "CT LOWER LEG WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73701",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737017",
            "Item/Package": "Item",
            "Description": "CT FOOT RT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73701",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737018",
            "Item/Package": "Item",
            "Description": "CT HIP LT W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73701",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737019",
            "Item/Package": "Item",
            "Description": "CT HIP RT W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73701",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737028",
            "Item/Package": "Item",
            "Description": "CT HIP LT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73702",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741600",
            "Item/Package": "Item",
            "Description": "CT ABDOMEN W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "74160",
            " Charge Amount ": " $1,943.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $1,360.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741700",
            "Item/Package": "Item",
            "Description": "CT ABDOMEN WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "74170",
            " Charge Amount ": " $2,432.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $1,702.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741740",
            "Item/Package": "Item",
            "Description": "CT ANGIO ABDOMEN PELVIS",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "74174",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741750",
            "Item/Package": "Item",
            "Description": "CT ANGIO ADBOMEN",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "74175",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741770",
            "Item/Package": "Item",
            "Description": "CT ABDOMEN/PELVIS W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "74177",
            " Charge Amount ": " $1,190.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $833.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7320014",
            "Item/Package": "Item",
            "Description": "CT SHOULDER LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73200",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7320015",
            "Item/Package": "Item",
            "Description": "CT SHOULDER RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73200",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7320111",
            "Item/Package": "Item",
            "Description": "CT SHOULDER LT W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73201",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7320112",
            "Item/Package": "Item",
            "Description": "CT SHOULDER RT W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73201",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7370010",
            "Item/Package": "Item",
            "Description": "CT HIP LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73700",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7370011",
            "Item/Package": "Item",
            "Description": "CT HIP RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73700",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7370012",
            "Item/Package": "Item",
            "Description": "CT KNEE LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73700",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7370013",
            "Item/Package": "Item",
            "Description": "CT KNEE RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73700",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7370110",
            "Item/Package": "Item",
            "Description": "CT KNEE LT W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73701",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "7370111",
            "Item/Package": "Item",
            "Description": "CT KNEE RT W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "352",
            "CPT/HCPCS/DRG": "73701",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100057",
            "Item/Package": "Item",
            "Description": "MM DIAG BREAST TOMO UNILAT/BL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "401",
            "CPT/HCPCS/DRG": "G0279",
            " Charge Amount ": " $521.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $364.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770610",
            "Item/Package": "Item",
            "Description": "BREAST TOMOSYNTHESIS UNI",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "401",
            "CPT/HCPCS/DRG": "77061",
            " Charge Amount ": " $401.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $280.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770620",
            "Item/Package": "Item",
            "Description": "BREAST TOMOSYNTHESIS BILATERAL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "401",
            "CPT/HCPCS/DRG": "77062",
            " Charge Amount ": " $521.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $364.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770650",
            "Item/Package": "Item",
            "Description": "MM DIAGN MAMMO UNILAT/CAD",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "401",
            "CPT/HCPCS/DRG": "77065",
            " Charge Amount ": " $545.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $381.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770660",
            "Item/Package": "Item",
            "Description": "MM DIAG MAMMO BL/CAD",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "401",
            "CPT/HCPCS/DRG": "77066",
            " Charge Amount ": " $693.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $485.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "765360",
            "Item/Package": "Item",
            "Description": "US SOFT TISSUE HEAD / NECK",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76536",
            " Charge Amount ": " $1,076.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $753.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "766040",
            "Item/Package": "Item",
            "Description": "US CHEST",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76604",
            " Charge Amount ": " $1,076.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $753.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "766410",
            "Item/Package": "Item",
            "Description": "US BREAST COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76641",
            " Charge Amount ": " $325.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $227.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "766420",
            "Item/Package": "Item",
            "Description": "US BREAST LIMITED",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76642",
            " Charge Amount ": " $311.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $217.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "767000",
            "Item/Package": "Item",
            "Description": "US ABDOMEN COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76700",
            " Charge Amount ": " $401.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $280.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "767050",
            "Item/Package": "Item",
            "Description": "US ABDOMEN LIMITED",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76705",
            " Charge Amount ": " $401.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $280.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "767060",
            "Item/Package": "Item",
            "Description": "US ABDL AORTA SCREEN AAA",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76706",
            " Charge Amount ": " $401.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $280.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "767700",
            "Item/Package": "Item",
            "Description": "US RETROPERITONEAL COMP",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76770",
            " Charge Amount ": " $401.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $280.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "767750",
            "Item/Package": "Item",
            "Description": "US RETROPERITONEAL LIMITED",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76775",
            " Charge Amount ": " $401.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $280.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "768300",
            "Item/Package": "Item",
            "Description": "US TRANSVAGINAL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76830",
            " Charge Amount ": " $1,076.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $753.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "768560",
            "Item/Package": "Item",
            "Description": "US PELVIC COMPLETE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76856",
            " Charge Amount ": " $401.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $280.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "768570",
            "Item/Package": "Item",
            "Description": "US PELVIC LIMITED",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76857",
            " Charge Amount ": " $401.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $280.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "768700",
            "Item/Package": "Item",
            "Description": "US SCROTUM",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76870",
            " Charge Amount ": " $401.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $280.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "768810",
            "Item/Package": "Item",
            "Description": "US EXTREMITY NONVASCULAR",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76881",
            " Charge Amount ": " $369.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $258.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "768820",
            "Item/Package": "Item",
            "Description": "US EXTREM NONVAS W IM DOC LTD",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76882",
            " Charge Amount ": " $242.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $169.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "769420",
            "Item/Package": "Item",
            "Description": "US GUIDED NEEDLE PLACEMENT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76942",
            " Charge Amount ": " $400.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $280.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "769780",
            "Item/Package": "Item",
            "Description": "US TRGT MBUBB 1ST LES",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76978",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "769810",
            "Item/Package": "Item",
            "Description": "US ELASTOGRAPHY ORGAN",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76981",
            " Charge Amount ": " $648.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $453.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "769820",
            "Item/Package": "Item",
            "Description": "US BREAST W EASTO 1ST LES",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76982",
            " Charge Amount ": " $572.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $400.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "769830",
            "Item/Package": "Item",
            "Description": "ULTRASOUND ELASTOGRAPHY EA ADL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76983",
            " Charge Amount ": " $287.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $200.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770530",
            "Item/Package": "Item",
            "Description": "MM DUC/GALACT SING DUC RAD S&I",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "77053",
            " Charge Amount ": " $736.00 ",
            " Min Reimb ": " $201.67 ",
            " Max Reimb ": " $515.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770540",
            "Item/Package": "Item",
            "Description": "MM DUC/GALACT MULT DUC RAD S&I",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "77054",
            " Charge Amount ": " $737.00 ",
            " Min Reimb ": " $201.67 ",
            " Max Reimb ": " $515.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770630",
            "Item/Package": "Item",
            "Description": "SCREEN DIGITAL BREAST TOMO BL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "403",
            "CPT/HCPCS/DRG": "77063",
            " Charge Amount ": " $521.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $364.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770670",
            "Item/Package": "Item",
            "Description": "MM SCREENING MAMMO BL/CAD",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "403",
            "CPT/HCPCS/DRG": "77067",
            " Charge Amount ": " $446.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $312.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "788150",
            "Item/Package": "Item",
            "Description": "PET W CT SKULL-THIGH",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "404",
            "CPT/HCPCS/DRG": "78815",
            " Charge Amount ": " $8,790.00 ",
            " Min Reimb ": " $894.04 ",
            " Max Reimb ": " $6,153.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "788160",
            "Item/Package": "Item",
            "Description": "PET W CT WHOLE BODY",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "404",
            "CPT/HCPCS/DRG": "78816",
            " Charge Amount ": " $8,741.00 ",
            " Min Reimb ": " $894.04 ",
            " Max Reimb ": " $6,118.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "705430",
            "Item/Package": "Item",
            "Description": "MR FACE WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "70543",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "705432",
            "Item/Package": "Item",
            "Description": "MR ORBIT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "70543",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "715500",
            "Item/Package": "Item",
            "Description": "MR CHEST",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "71550",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "715510",
            "Item/Package": "Item",
            "Description": "MR CHEST W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "71551",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $338.48 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721950",
            "Item/Package": "Item",
            "Description": "MR PELVIS WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "72195",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721960",
            "Item/Package": "Item",
            "Description": "MR SACRUM W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "72196",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721970",
            "Item/Package": "Item",
            "Description": "MR PELVIS WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "72197",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732180",
            "Item/Package": "Item",
            "Description": "MR EXTREMITY UPPER WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73218",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732182",
            "Item/Package": "Item",
            "Description": "MR FOREARM LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73218",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732183",
            "Item/Package": "Item",
            "Description": "MR FOREARM RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73218",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732184",
            "Item/Package": "Item",
            "Description": "MR HUMERUS LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73218",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732185",
            "Item/Package": "Item",
            "Description": "MR HUMERUS RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73218",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732202",
            "Item/Package": "Item",
            "Description": "MR ELBOW LT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73220",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732204",
            "Item/Package": "Item",
            "Description": "MR FOREARM LT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73220",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732205",
            "Item/Package": "Item",
            "Description": "MR FOREARM RT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73220",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732207",
            "Item/Package": "Item",
            "Description": "MR HUMERUS RT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73220",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732212",
            "Item/Package": "Item",
            "Description": "MR ELBOW LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73221",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732213",
            "Item/Package": "Item",
            "Description": "MR ELBOW RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73221",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732216",
            "Item/Package": "Item",
            "Description": "MR SHOULDER LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73221",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732217",
            "Item/Package": "Item",
            "Description": "MR SHOULDER RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73221",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732218",
            "Item/Package": "Item",
            "Description": "MR WRIST LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73221",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732219",
            "Item/Package": "Item",
            "Description": "MR WRIST RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73221",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732226",
            "Item/Package": "Item",
            "Description": "MR SHOULDER LT W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73222",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $338.48 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732227",
            "Item/Package": "Item",
            "Description": "MR SHOULDER RT W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73222",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $338.48 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732234",
            "Item/Package": "Item",
            "Description": "MR SHOULDER LT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73223",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732235",
            "Item/Package": "Item",
            "Description": "MR SHOULDER RT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73223",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "732237",
            "Item/Package": "Item",
            "Description": "MR WRIST RT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73223",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737180",
            "Item/Package": "Item",
            "Description": "MR EXTREMITY LOWER WO CONTRAST",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73718",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737182",
            "Item/Package": "Item",
            "Description": "MR FEMUR LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73718",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737183",
            "Item/Package": "Item",
            "Description": "MR FEMUR RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73718",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737184",
            "Item/Package": "Item",
            "Description": "MR LOWER LEG LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73718",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737185",
            "Item/Package": "Item",
            "Description": "MR LOWER LEG RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73718",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737200",
            "Item/Package": "Item",
            "Description": "MR LEG FOOT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73720",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737202",
            "Item/Package": "Item",
            "Description": "MR FEMUR LT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73720",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737203",
            "Item/Package": "Item",
            "Description": "MR FEMUR RT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73720",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737204",
            "Item/Package": "Item",
            "Description": "MR LOWER LEG LT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73720",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737205",
            "Item/Package": "Item",
            "Description": "MR LOWER LEG RT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73720",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737212",
            "Item/Package": "Item",
            "Description": "MR ANKLE LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73721",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737213",
            "Item/Package": "Item",
            "Description": "MR ANKLE RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73721",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737216",
            "Item/Package": "Item",
            "Description": "MR HIP LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73721",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737217",
            "Item/Package": "Item",
            "Description": "MR HIP RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73721",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737218",
            "Item/Package": "Item",
            "Description": "MR KNEE LT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73721",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737219",
            "Item/Package": "Item",
            "Description": "MR KNEE RT WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73721",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737226",
            "Item/Package": "Item",
            "Description": "MR HIP LT W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73722",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $338.48 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737227",
            "Item/Package": "Item",
            "Description": "MR HIP RT W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73722",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $338.48 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737228",
            "Item/Package": "Item",
            "Description": "MR KNEE LT W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73722",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $338.48 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737232",
            "Item/Package": "Item",
            "Description": "MR ANKLE LT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73723",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737234",
            "Item/Package": "Item",
            "Description": "MR HIP LT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73723",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737235",
            "Item/Package": "Item",
            "Description": "MR HIP RT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73723",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737236",
            "Item/Package": "Item",
            "Description": "MR KNEE LT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73723",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "737237",
            "Item/Package": "Item",
            "Description": "MR KNEE RT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "73723",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741810",
            "Item/Package": "Item",
            "Description": "MR ABDOMEN",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "74181",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741830",
            "Item/Package": "Item",
            "Description": "MR ABDOMEN W W/O CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "74183",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770470",
            "Item/Package": "Item",
            "Description": "MR BREAST BI WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "77047",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770482",
            "Item/Package": "Item",
            "Description": "MR BREAST LT WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "77048",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770490",
            "Item/Package": "Item",
            "Description": "MR BREAST BI WO/ W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "610",
            "CPT/HCPCS/DRG": "77049",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "705510",
            "Item/Package": "Item",
            "Description": "MR HEAD/BRAIN WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "611",
            "CPT/HCPCS/DRG": "70551",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "705520",
            "Item/Package": "Item",
            "Description": "MR HEAD/BRAIN W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "611",
            "CPT/HCPCS/DRG": "70552",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "705530",
            "Item/Package": "Item",
            "Description": "MR HEAD/BRAIN WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "611",
            "CPT/HCPCS/DRG": "70553",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721410",
            "Item/Package": "Item",
            "Description": "MR CERVICAL SPINE WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "612",
            "CPT/HCPCS/DRG": "72141",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721420",
            "Item/Package": "Item",
            "Description": "MR CERVICAL SPINE W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "612",
            "CPT/HCPCS/DRG": "72142",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721460",
            "Item/Package": "Item",
            "Description": "MR THORACID SPINE WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "612",
            "CPT/HCPCS/DRG": "72146",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721470",
            "Item/Package": "Item",
            "Description": "MR THORACIC SPINE W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "612",
            "CPT/HCPCS/DRG": "72147",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721480",
            "Item/Package": "Item",
            "Description": "MR LUMBAR SPINE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "612",
            "CPT/HCPCS/DRG": "72148",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721490",
            "Item/Package": "Item",
            "Description": "MR LUMBAR SPINE W/ CONTRAST",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "612",
            "CPT/HCPCS/DRG": "72149",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721560",
            "Item/Package": "Item",
            "Description": "MR NECK SPINE W/OUT/W/ CONT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "612",
            "CPT/HCPCS/DRG": "72156",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721570",
            "Item/Package": "Item",
            "Description": "MR THORACIC SPINE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "612",
            "CPT/HCPCS/DRG": "72157",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721580",
            "Item/Package": "Item",
            "Description": "MR LUMBAR SPINE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "612",
            "CPT/HCPCS/DRG": "72158",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100052",
            "Item/Package": "Item",
            "Description": "MRI BREAST BL W/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "614",
            "CPT/HCPCS/DRG": "C8908",
            " Charge Amount ": " $5,390.00 ",
            " Min Reimb ": " $323.20 ",
            " Max Reimb ": " $3,772.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "705440",
            "Item/Package": "Item",
            "Description": "MR ANGIO HEAD WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "615",
            "CPT/HCPCS/DRG": "70544",
            " Charge Amount ": " $4,522.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,165.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "705470",
            "Item/Package": "Item",
            "Description": "MR ANGIO NECK WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "615",
            "CPT/HCPCS/DRG": "70547",
            " Charge Amount ": " $4,522.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $3,165.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "705490",
            "Item/Package": "Item",
            "Description": "MR ANGIO NECK WO/W CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "615",
            "CPT/HCPCS/DRG": "70549",
            " Charge Amount ": " $4,522.00 ",
            " Min Reimb ": " $274.25 ",
            " Max Reimb ": " $3,165.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100050",
            "Item/Package": "Item",
            "Description": "MRA ABD W/WO CON",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "618",
            "CPT/HCPCS/DRG": "C8902",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $274.25 ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "741850",
            "Item/Package": "Item",
            "Description": "MR ABDOMEN MRA",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "618",
            "CPT/HCPCS/DRG": "74185",
            " Charge Amount ": " $4,929.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3,450.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90425",
            "Item/Package": "Item",
            "Description": "LIDOCAINE 1% 20 ML",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2001",
            " Charge Amount ": " $11.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90479",
            "Item/Package": "Item",
            "Description": "DEPOMEDROL METHYLPRED 80MG/ML",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1040",
            " Charge Amount ": " $86.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $60.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90718",
            "Item/Package": "Item",
            "Description": "TRIAMCINOLONE(KENALOG) 10 MG/M",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3301",
            " Charge Amount ": " $66.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $46.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90765",
            "Item/Package": "Item",
            "Description": "INJ MULTIHANCE PER 1 ML",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "A9577",
            " Charge Amount ": " $12.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $8.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90770",
            "Item/Package": "Item",
            "Description": "LASIX INJ TO 20 MG",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1940",
            " Charge Amount ": " $13.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90771",
            "Item/Package": "Item",
            "Description": "ROPIVACAINE HCL INJ 1 MG",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2795",
            " Charge Amount ": " $34.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90775",
            "Item/Package": "Item",
            "Description": "LOCM 200-299MG/ML IODINE 1ML",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "Q9966",
            " Charge Amount ": " $4.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90776",
            "Item/Package": "Item",
            "Description": "LOCM 300-399MG/ML IODINE 1ML",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "Q9967",
            " Charge Amount ": " $4.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90846",
            "Item/Package": "Item",
            "Description": "LUMASON 24.01/ML CHG BY ML",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "Q9950",
            " Charge Amount ": " $167.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $116.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "20606",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ INTER JOINT/BURSA/US",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20606",
            " Charge Amount ": " $2,364.00 ",
            " Min Reimb ": " $426.37 ",
            " Max Reimb ": " $1,654.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100067",
            "Item/Package": "Item",
            "Description": "FNA BX W US 1ST LES",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "10005",
            " Charge Amount ": " $1,897.00 ",
            " Min Reimb ": " $545.86 ",
            " Max Reimb ": " $1,327.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100068",
            "Item/Package": "Item",
            "Description": "FNA W US EA ADDL LES",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "10006",
            " Charge Amount ": " $1,897.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,327.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "101600",
            "Item/Package": "Item",
            "Description": "PUNCTURE ASPIR ABSCESS/ HEMATO",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "10160",
            " Charge Amount ": " $2,024.00 ",
            " Min Reimb ": " $201.91 ",
            " Max Reimb ": " $1,416.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "190000",
            "Item/Package": "Item",
            "Description": "DRAINAGE OF BREAST LESION",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "19000",
            " Charge Amount ": " $1,629.00 ",
            " Min Reimb ": " $545.86 ",
            " Max Reimb ": " $1,140.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "190010",
            "Item/Package": "Item",
            "Description": "ASPIRATION EACH ADDL CYST",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "19001",
            " Charge Amount ": " $1,629.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1,140.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "190300",
            "Item/Package": "Item",
            "Description": "MM DUCTOGRAM MULTI DUCTS LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "19030",
            " Charge Amount ": " $313.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $219.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "190302",
            "Item/Package": "Item",
            "Description": "MM DUCTOGRAM MULTI DUCTS LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "19030",
            " Charge Amount ": " $313.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $219.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "190304",
            "Item/Package": "Item",
            "Description": "MM DUCTOGRAM MULTI DUCT LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "19030",
            " Charge Amount ": " $313.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $219.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "190305",
            "Item/Package": "Item",
            "Description": "MM DUCTOGRAM MULTI DUCT RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "19030",
            " Charge Amount ": " $313.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $219.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "190810",
            "Item/Package": "Item",
            "Description": "BX BREAST 1ST LESION STRTCTC",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "19081",
            " Charge Amount ": " $2,016.00 ",
            " Min Reimb ": " $991.88 ",
            " Max Reimb ": " $1,411.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "190830",
            "Item/Package": "Item",
            "Description": "US BX BREAST PERC W IMAGE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "19083",
            " Charge Amount ": " $1,304.00 ",
            " Min Reimb ": " $991.88 ",
            " Max Reimb ": " $912.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "190840",
            "Item/Package": "Item",
            "Description": "US IMAG BX BREAST ADD LESION",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "19084",
            " Charge Amount ": " $686.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $480.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "191000",
            "Item/Package": "Item",
            "Description": "BX BREAST PERCUT W/O IMAGE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "19100",
            " Charge Amount ": " $3,339.00 ",
            " Min Reimb ": " $991.88 ",
            " Max Reimb ": " $2,337.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "192812",
            "Item/Package": "Item",
            "Description": "MM NEEDLE LOC LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "19281",
            " Charge Amount ": " $1,967.00 ",
            " Min Reimb ": " $546.08 ",
            " Max Reimb ": " $1,376.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "202060",
            "Item/Package": "Item",
            "Description": "BX MUSCLE PERC NEEDLE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20206",
            " Charge Amount ": " $2,780.00 ",
            " Min Reimb ": " $545.86 ",
            " Max Reimb ": " $1,945.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205500",
            "Item/Package": "Item",
            "Description": "INJ TRIGGER PT TENDON SHEATH",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20550",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205520",
            "Item/Package": "Item",
            "Description": "TRIGGER POINT 1-2 MUSC GRPS",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20552",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206008",
            "Item/Package": "Item",
            "Description": "INJ SMALL JNT FINGER/TOE RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20600",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206040",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ SMALL JOINT/BUR W/US",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20604",
            " Charge Amount ": " $812.00 ",
            " Min Reimb ": " $229.30 ",
            " Max Reimb ": " $568.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206050",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ JOINT/BURSA LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20605",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206058",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ JOINT/BURSA RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20605",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206100",
            "Item/Package": "Item",
            "Description": "ARTHRO MAJOR JOINT/BURSA LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20610",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206104",
            "Item/Package": "Item",
            "Description": "ARTHRO MAJOR JOINT OR BURSA BL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20610",
            " Charge Amount ": " $1,588.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $1,111.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206108",
            "Item/Package": "Item",
            "Description": "ARTHRO MAJOR JOINT/BURSA RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20610",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206110",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ MAJ JOINT/BURSA W/US",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20611",
            " Charge Amount ": " $812.00 ",
            " Min Reimb ": " $229.30 ",
            " Max Reimb ": " $568.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "233500",
            "Item/Package": "Item",
            "Description": "INJECT PROC/SHOULDER ARTHRO",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "23350",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "243570",
            "Item/Package": "Item",
            "Description": "PERC TENOLYSIS",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "24357",
            " Charge Amount ": " $812.00 ",
            " Min Reimb ": " $1,245.31 ",
            " Max Reimb ": " $568.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "273700",
            "Item/Package": "Item",
            "Description": "INJ KNEE X-RAY",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "27369",
            " Charge Amount ": " $732.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $512.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "385050",
            "Item/Package": "Item",
            "Description": "US BIPOSY LYMPH NODE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "38505",
            " Charge Amount ": " $1,729.00 ",
            " Min Reimb ": " $1,235.32 ",
            " Max Reimb ": " $1,210.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "387920",
            "Item/Package": "Item",
            "Description": "INJ PROCED ID SENTINEL NODE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "38792",
            " Charge Amount ": " $876.00 ",
            " Min Reimb ": " $250.12 ",
            " Max Reimb ": " $613.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "490830",
            "Item/Package": "Item",
            "Description": "CT DRAIN PARACENTESIS",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "49083",
            " Charge Amount ": " $2,023.00 ",
            " Min Reimb ": " $525.31 ",
            " Max Reimb ": " $1,416.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "516000",
            "Item/Package": "Item",
            "Description": "INJECTION PROCEDURE CYSTOGRAM",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "51600",
            " Charge Amount ": " $700.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $489.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "583400",
            "Item/Package": "Item",
            "Description": "INJ FOR HYSTEROSALPGRPHY",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "58340",
            " Charge Amount ": " $737.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $515.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644470",
            "Item/Package": "Item",
            "Description": "INJ FEMORAL NB SINGLE",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "64447",
            " Charge Amount ": " $2,064.00 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $1,444.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "0232T",
            "Item/Package": "Item",
            "Description": "NJX PLATELET PLASMA",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "0232T",
            " Charge Amount ": " $983.00 ",
            " Min Reimb ": " $237.25 ",
            " Max Reimb ": " $688.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939300",
            "Item/Package": "Item",
            "Description": "US UE ART/BPG BL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "93930",
            " Charge Amount ": " $1,076.00 ",
            " Min Reimb ": " $155.83 ",
            " Max Reimb ": " $753.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939792",
            "Item/Package": "Item",
            "Description": "US DUPLEX ILIAC LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "93979",
            " Charge Amount ": " $1,076.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $753.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939793",
            "Item/Package": "Item",
            "Description": "US DUPLEX ILIAC RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "920",
            "CPT/HCPCS/DRG": "93979",
            " Charge Amount ": " $1,076.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $753.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "938800",
            "Item/Package": "Item",
            "Description": "CAROTID DUPLEX SCAN BILAT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93880",
            " Charge Amount ": " $1,896.00 ",
            " Min Reimb ": " $155.83 ",
            " Max Reimb ": " $1,327.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939252",
            "Item/Package": "Item",
            "Description": "US ARTERIAL DUPLEX LE BI",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93925",
            " Charge Amount ": " $1,076.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $753.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939262",
            "Item/Package": "Item",
            "Description": "US ARTERIAL DUPLEX LE LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93926",
            " Charge Amount ": " $1,076.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $753.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939263",
            "Item/Package": "Item",
            "Description": "US ARTERIAL DUPLEX LE RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93926",
            " Charge Amount ": " $1,076.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $753.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939310",
            "Item/Package": "Item",
            "Description": "DUPLEX UE ART/BPPG UNIL/LMIT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93931",
            " Charge Amount ": " $1,076.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $753.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939704",
            "Item/Package": "Item",
            "Description": "US VENOUS DOPPLER LE BI",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93970",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939705",
            "Item/Package": "Item",
            "Description": "US VENOUS DOPPLER UE BI",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93970",
            " Charge Amount ": " $638.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $446.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939712",
            "Item/Package": "Item",
            "Description": "US VENOUS DOPPLER LE LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93971",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939713",
            "Item/Package": "Item",
            "Description": "US VENOUS DOPPLER LE RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93971",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939714",
            "Item/Package": "Item",
            "Description": "US VENOUS DOPPLER UE LT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93971",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939715",
            "Item/Package": "Item",
            "Description": "US VENOUS DOPPLER UE RT",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93971",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939750",
            "Item/Package": "Item",
            "Description": "DUPLEX ARTERIAL FLOW COMPL",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93975",
            " Charge Amount ": " $1,076.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $753.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "I000000009",
            "Item/Package": "Item",
            "Description": "FOUNDATION RADIOLOGY READ",
            "Location": "Southwoods Imaging - Boardman",
            "Revenue Code": "3333",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "700300",
            "Item/Package": "Item",
            "Description": "XR EYE FOREIGN BODY LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70030",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701000",
            "Item/Package": "Item",
            "Description": "XR MANDIBLE LIMITED < 4V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701100",
            "Item/Package": "Item",
            "Description": "XR MANDIBLE COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70110",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701300",
            "Item/Package": "Item",
            "Description": "X-RAY EXAM OF MASTOIDS 3V>",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70130",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701500",
            "Item/Package": "Item",
            "Description": "XR FACIAL BONES > 3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70150",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701600",
            "Item/Package": "Item",
            "Description": "XR NASAL BONE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70160",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701900",
            "Item/Package": "Item",
            "Description": "XR EYE SOCKETS",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70190",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702000",
            "Item/Package": "Item",
            "Description": "XR ORBIT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70200",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702100",
            "Item/Package": "Item",
            "Description": "XR SINUS WATERS VIEW",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70210",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702200",
            "Item/Package": "Item",
            "Description": "XR SINUSES",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70220",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702500",
            "Item/Package": "Item",
            "Description": "XR SKULL < 4 VIEWS",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70250",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702600",
            "Item/Package": "Item",
            "Description": "XR SKULL COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70260",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "703600",
            "Item/Package": "Item",
            "Description": "XR SOFT TISSUE NECK",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70360",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720200",
            "Item/Package": "Item",
            "Description": "XR LUMBAR SPINE 1V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720400",
            "Item/Package": "Item",
            "Description": "XR SPINE CERVICAL 3 V/L",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72040",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720500",
            "Item/Package": "Item",
            "Description": "XR SPINE CERVICAL 4 OR 5 VIEWS",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72050",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720520",
            "Item/Package": "Item",
            "Description": "XR SPINE CERVICAL W FLEX EXTEN",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72052",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720690",
            "Item/Package": "Item",
            "Description": "XR SPINE THORAC SCOLIOSIS",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72069",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720700",
            "Item/Package": "Item",
            "Description": "XR THORACIC SPINE 2 V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72070",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720720",
            "Item/Package": "Item",
            "Description": "XR THORACIC SPINE 3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72072",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720740",
            "Item/Package": "Item",
            "Description": "XR THORAC SPINE 4 V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72074",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720800",
            "Item/Package": "Item",
            "Description": "XR TRUNK SPINE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720900",
            "Item/Package": "Item",
            "Description": "XR TRUNK SPINE 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72090",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721000",
            "Item/Package": "Item",
            "Description": "XR LUMBAR SPINE  2-3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721100",
            "Item/Package": "Item",
            "Description": "XR LOWER SPINE MIN 4V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72110",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721140",
            "Item/Package": "Item",
            "Description": "XR LUMBAR SPINE 6V W BENDING",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72114",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721700",
            "Item/Package": "Item",
            "Description": "XR PELVIS AP VIEW",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72170",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721900",
            "Item/Package": "Item",
            "Description": "XR PELVIS MIN 3 V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72190",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "722000",
            "Item/Package": "Item",
            "Description": "XR SACROILIAC JOINT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72200",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "722020",
            "Item/Package": "Item",
            "Description": "XR SACROILIAC JOINTS",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72202",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "722200",
            "Item/Package": "Item",
            "Description": "XR SACRUM COCYX",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72220",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730000",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE BL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730002",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730003",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE RT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730004",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE BI",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730100",
            "Item/Package": "Item",
            "Description": "XR SCAPULA LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730103",
            "Item/Package": "Item",
            "Description": "XR SCAPULA RT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730104",
            "Item/Package": "Item",
            "Description": "XR SCAPULA BL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730200",
            "Item/Package": "Item",
            "Description": "XR SHOULDER 1V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730202",
            "Item/Package": "Item",
            "Description": "XR SHOULDER LT 1V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730203",
            "Item/Package": "Item",
            "Description": "XR SHOULDER RT 1V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730204",
            "Item/Package": "Item",
            "Description": "XR SHOULDER RT BL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730300",
            "Item/Package": "Item",
            "Description": "XR SHOULDER COMPLETE BL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73030",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730302",
            "Item/Package": "Item",
            "Description": "XR SHOULDER LT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73030",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730303",
            "Item/Package": "Item",
            "Description": "XR SHOULDER RT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73030",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730400",
            "Item/Package": "Item",
            "Description": "XR SHOULDER W CON",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73040",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $201.67 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730500",
            "Item/Package": "Item",
            "Description": "XR SHOULDERS",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73050",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730504",
            "Item/Package": "Item",
            "Description": "XR AC JOINT BI",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73050",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730600",
            "Item/Package": "Item",
            "Description": "XR HUMERUS",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730602",
            "Item/Package": "Item",
            "Description": "XR HUMERUS LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730603",
            "Item/Package": "Item",
            "Description": "XR HUMERUS RT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730604",
            "Item/Package": "Item",
            "Description": "XR HUMERUS BL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730700",
            "Item/Package": "Item",
            "Description": "XR ELBOW BL LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73070",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730702",
            "Item/Package": "Item",
            "Description": "XR ELBOW LT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73070",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730703",
            "Item/Package": "Item",
            "Description": "XR ELBOW RT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73070",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730800",
            "Item/Package": "Item",
            "Description": "XR ELBOW MIN 3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730802",
            "Item/Package": "Item",
            "Description": "XR ELBOW LT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730803",
            "Item/Package": "Item",
            "Description": "XR ELBOW RT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730804",
            "Item/Package": "Item",
            "Description": "XR ELBOW BI COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730900",
            "Item/Package": "Item",
            "Description": "XR EX OF FOREARM 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730902",
            "Item/Package": "Item",
            "Description": "XR FOREARM LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730903",
            "Item/Package": "Item",
            "Description": "XR FOREARM RT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730904",
            "Item/Package": "Item",
            "Description": "XR FOREARM BL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731000",
            "Item/Package": "Item",
            "Description": "XR EXOF WRIST 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731002",
            "Item/Package": "Item",
            "Description": "XR WRIST LT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731003",
            "Item/Package": "Item",
            "Description": "XR WRIST RT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731004",
            "Item/Package": "Item",
            "Description": "XR WRIST BL LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731100",
            "Item/Package": "Item",
            "Description": "XR WRIST BL COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73110",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731102",
            "Item/Package": "Item",
            "Description": "XR WRIST LT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73110",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731103",
            "Item/Package": "Item",
            "Description": "XR WRIST RT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73110",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731200",
            "Item/Package": "Item",
            "Description": "XR HAND 2 VIEWS",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731202",
            "Item/Package": "Item",
            "Description": "XR HAND LT 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731203",
            "Item/Package": "Item",
            "Description": "XR HAND RT 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731204",
            "Item/Package": "Item",
            "Description": "XR HANS BL 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731300",
            "Item/Package": "Item",
            "Description": "XR HAND BL 3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73130",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731302",
            "Item/Package": "Item",
            "Description": "XR HAND LT 3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73130",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731303",
            "Item/Package": "Item",
            "Description": "XR HAND RT 3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73130",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731400",
            "Item/Package": "Item",
            "Description": "XR FINGERS",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73140",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731402",
            "Item/Package": "Item",
            "Description": "XR FINGER LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73140",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731403",
            "Item/Package": "Item",
            "Description": "XR FINGER RT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73140",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735010",
            "Item/Package": "Item",
            "Description": "XR HIP UNI 1V RT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73501",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735012",
            "Item/Package": "Item",
            "Description": "XR HIP UNI 1V LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73501",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735020",
            "Item/Package": "Item",
            "Description": "XR HIP UNI W/PELVIS 2-3/V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73502",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735022",
            "Item/Package": "Item",
            "Description": "XR HIP UNI/PELVIS 2-3V RT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73502",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735023",
            "Item/Package": "Item",
            "Description": "XR HIP UNI/PELVIS 2-3V LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73502",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735210",
            "Item/Package": "Item",
            "Description": "XR Hips BL W/PELVIS 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73521",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735510",
            "Item/Package": "Item",
            "Description": "XR FEMUR 1 V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73551",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735520",
            "Item/Package": "Item",
            "Description": "XR FEMUR 2/> BL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73552",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735522",
            "Item/Package": "Item",
            "Description": "XR FEMUR 2/> RT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73552",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735523",
            "Item/Package": "Item",
            "Description": "XR FEMUR 2/>LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73552",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735600",
            "Item/Package": "Item",
            "Description": "XR KNEE LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735602",
            "Item/Package": "Item",
            "Description": "XR KNEE LT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735603",
            "Item/Package": "Item",
            "Description": "XR KNEE RT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735604",
            "Item/Package": "Item",
            "Description": "XR KNEE BL LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735620",
            "Item/Package": "Item",
            "Description": "XR KNEE 3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735622",
            "Item/Package": "Item",
            "Description": "XR KNEE LT 3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735623",
            "Item/Package": "Item",
            "Description": "XR KNEE RT 3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735624",
            "Item/Package": "Item",
            "Description": "XR KNEE BL 3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735640",
            "Item/Package": "Item",
            "Description": "XR KNEE BL 4V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73564",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735642",
            "Item/Package": "Item",
            "Description": "XR KNEE LT 4V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73564",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735643",
            "Item/Package": "Item",
            "Description": "XR KNEE RT 4V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73564",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735650",
            "Item/Package": "Item",
            "Description": "XR KNEE STANDING AP BL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73565",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735900",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735902",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735903",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA RT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735904",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA BL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736000",
            "Item/Package": "Item",
            "Description": "XR ANKLE LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736002",
            "Item/Package": "Item",
            "Description": "XR ANKLE LT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736003",
            "Item/Package": "Item",
            "Description": "XR ANKLE RT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736004",
            "Item/Package": "Item",
            "Description": "XR ANKLE BL LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736100",
            "Item/Package": "Item",
            "Description": "XR ANKLE BL COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73610",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736102",
            "Item/Package": "Item",
            "Description": "XR ANKLE LT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73610",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736103",
            "Item/Package": "Item",
            "Description": "XR ANKLE RT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73610",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736200",
            "Item/Package": "Item",
            "Description": "XR FOOT 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736202",
            "Item/Package": "Item",
            "Description": "XR FOOT LT 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736203",
            "Item/Package": "Item",
            "Description": "XR FOOT RT 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736204",
            "Item/Package": "Item",
            "Description": "XR FOOT BL 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736300",
            "Item/Package": "Item",
            "Description": "XR FOOT 3 V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736302",
            "Item/Package": "Item",
            "Description": "XR FOOT LT 3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736303",
            "Item/Package": "Item",
            "Description": "XR FOOT RT 3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736304",
            "Item/Package": "Item",
            "Description": "XR FOOT BL 3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736500",
            "Item/Package": "Item",
            "Description": "XR HEEL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736502",
            "Item/Package": "Item",
            "Description": "XR CALCANEUS LT 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736503",
            "Item/Package": "Item",
            "Description": "XR CALCANEUS RT 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736504",
            "Item/Package": "Item",
            "Description": "XR CALCANEUS BI 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736600",
            "Item/Package": "Item",
            "Description": "XR TOES",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73660",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736602",
            "Item/Package": "Item",
            "Description": "XR TOES LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73660",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736603",
            "Item/Package": "Item",
            "Description": "XR TOES RT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73660",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740000",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN 1V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740100",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN W/OBLIQUE/CONE V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740200",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74020",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740220",
            "Item/Package": "Item",
            "Description": "XR SERIES ABDOMEN",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74022",
            " Charge Amount ": " $572.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $400.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "742500",
            "Item/Package": "Item",
            "Description": "XR SMALL BOWEL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74250",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770730",
            "Item/Package": "Item",
            "Description": "XR BONE LENGTH",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "77073",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710100",
            "Item/Package": "Item",
            "Description": "XR CHEST 1V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710200",
            "Item/Package": "Item",
            "Description": "XR CHEST 2V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71020",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710210",
            "Item/Package": "Item",
            "Description": "XR CHEST 2V/APICAL LORDOTI PRO",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71021",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710220",
            "Item/Package": "Item",
            "Description": "XR CHEST 2V W/ OBLIQUE PROJ",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71022",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710300",
            "Item/Package": "Item",
            "Description": "XR CHEST & DECUBITUS VIEWS",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71030",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711000",
            "Item/Package": "Item",
            "Description": "XR RIBS",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71100",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711002",
            "Item/Package": "Item",
            "Description": "XR RIBS LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711003",
            "Item/Package": "Item",
            "Description": "XR RIBS RT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71100",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711010",
            "Item/Package": "Item",
            "Description": "XR RIBS CHEST",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71101",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711100",
            "Item/Package": "Item",
            "Description": "XR RIBS BL 3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71110",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711110",
            "Item/Package": "Item",
            "Description": "XR RIBS CHEST,POSTEROANTER 4V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71111",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711114",
            "Item/Package": "Item",
            "Description": "XR RIBS BI",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71111",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711200",
            "Item/Package": "Item",
            "Description": "XR STERNUM",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71120",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711300",
            "Item/Package": "Item",
            "Description": "XR BREASTBONE 3V",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71130",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90479",
            "Item/Package": "Item",
            "Description": "DEPOMEDROL METHYLPRED 80MG/ML",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1040",
            " Charge Amount ": " $86.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $60.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90902",
            "Item/Package": "Item",
            "Description": "CELESTONE 6MG/ML 5ML VIAL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0702",
            " Charge Amount ": " $35.15 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90923",
            "Item/Package": "Item",
            "Description": "SYNVISC 16 MG SYRINGE/ I MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7325",
            " Charge Amount ": " $76.41 ",
            " Min Reimb ": " $9.37 ",
            " Max Reimb ": " $53.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90924",
            "Item/Package": "Item",
            "Description": "KENALOG VIAL/10 MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3301",
            " Charge Amount ": " $11.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90926",
            "Item/Package": "Item",
            "Description": "HYALGAN/SUPARTZ/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7321",
            " Charge Amount ": " $436.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $305.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90927",
            "Item/Package": "Item",
            "Description": "EUFLEXXA/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7323",
            " Charge Amount ": " $969.60 ",
            " Min Reimb ": " $55.25 ",
            " Max Reimb ": " $678.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90928",
            "Item/Package": "Item",
            "Description": "ORTHOVISC/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7324",
            " Charge Amount ": " $899.40 ",
            " Min Reimb ": " $55.25 ",
            " Max Reimb ": " $629.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90929",
            "Item/Package": "Item",
            "Description": "SYNVISC ONE 48 MG1 1 MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7325",
            " Charge Amount ": " $52.29 ",
            " Min Reimb ": " $9.37 ",
            " Max Reimb ": " $36.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90930",
            "Item/Package": "Item",
            "Description": "GEL ONE/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7326",
            " Charge Amount ": " $2,188.00 ",
            " Min Reimb ": " $325.62 ",
            " Max Reimb ": " $1,531.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90931",
            "Item/Package": "Item",
            "Description": "MONOVISC/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7327",
            " Charge Amount ": " $2,426.00 ",
            " Min Reimb ": " $593.50 ",
            " Max Reimb ": " $1,698.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90932",
            "Item/Package": "Item",
            "Description": "GELSYN/16.8 MG/.1 MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7328",
            " Charge Amount ": " $9.39 ",
            " Min Reimb ": " $1.91 ",
            " Max Reimb ": " $6.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90933",
            "Item/Package": "Item",
            "Description": "ABATACEPT 10MG/10MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0129",
            " Charge Amount ": " $91.00 ",
            " Min Reimb ": " $49.93 ",
            " Max Reimb ": " $63.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90934",
            "Item/Package": "Item",
            "Description": "BELIMUMAB 120 MG/10MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0490",
            " Charge Amount ": " $78.00 ",
            " Min Reimb ": " $41.12 ",
            " Max Reimb ": " $54.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90936",
            "Item/Package": "Item",
            "Description": "BETAMETHA. AC & PHOS 3MG/3MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0702",
            " Charge Amount ": " $13.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90937",
            "Item/Package": "Item",
            "Description": "CERTOLIZUMAB PEGOL 1MG/1MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0717",
            " Charge Amount ": " $14.00 ",
            " Min Reimb ": " $7.18 ",
            " Max Reimb ": " $9.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90939",
            "Item/Package": "Item",
            "Description": "DEPO MEDROL 20MG/20 MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1020",
            " Charge Amount ": " $22.02 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90940",
            "Item/Package": "Item",
            "Description": "DEPO MEDROL 40 MG/40MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1030",
            " Charge Amount ": " $42.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90941",
            "Item/Package": "Item",
            "Description": "DEPO MEDROL 80MG/80 MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1040",
            " Charge Amount ": " $86.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $60.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90942",
            "Item/Package": "Item",
            "Description": "GOLIMUMAB IV 1MG/1MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1602",
            " Charge Amount ": " $41.00 ",
            " Min Reimb ": " $15.92 ",
            " Max Reimb ": " $28.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90943",
            "Item/Package": "Item",
            "Description": "INFLIXIMAB 10MG/10MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1745",
            " Charge Amount ": " $135.00 ",
            " Min Reimb ": " $39.43 ",
            " Max Reimb ": " $94.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90944",
            "Item/Package": "Item",
            "Description": "TORADOL 15 MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1885",
            " Charge Amount ": " $5.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90946",
            "Item/Package": "Item",
            "Description": "SOLU MEDROL 125MG/125MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2930",
            " Charge Amount ": " $13.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90947",
            "Item/Package": "Item",
            "Description": "ACTEMRA 80MG/1MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3262",
            " Charge Amount ": " $9.00 ",
            " Min Reimb ": " $4.80 ",
            " Max Reimb ": " $6.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90949",
            "Item/Package": "Item",
            "Description": "ACTEMRA 400MG/1MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3262",
            " Charge Amount ": " $9.00 ",
            " Min Reimb ": " $4.80 ",
            " Max Reimb ": " $6.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90950",
            "Item/Package": "Item",
            "Description": "KENALOG 10MG/10 MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3301",
            " Charge Amount ": " $3.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90951",
            "Item/Package": "Item",
            "Description": "VIT B-12 INJ 1000MCG/1000MCG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3420",
            " Charge Amount ": " $13.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90952",
            "Item/Package": "Item",
            "Description": "ZOLEDRONIC ACID 1MG/1MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3489",
            " Charge Amount ": " $74.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $51.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90954",
            "Item/Package": "Item",
            "Description": "SUPARTZ/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7321",
            " Charge Amount ": " $436.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $305.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90955",
            "Item/Package": "Item",
            "Description": "EUFLEXXA/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7323",
            " Charge Amount ": " $969.60 ",
            " Min Reimb ": " $55.25 ",
            " Max Reimb ": " $678.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90956",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE HCL/PF 7.5MG/ML 30",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7324",
            " Charge Amount ": " $299.00 ",
            " Min Reimb ": " $55.25 ",
            " Max Reimb ": " $209.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90959",
            "Item/Package": "Item",
            "Description": "MONOVISC/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7327",
            " Charge Amount ": " $2,426.00 ",
            " Min Reimb ": " $593.50 ",
            " Max Reimb ": " $1,698.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90960",
            "Item/Package": "Item",
            "Description": "GELSYN-3/CHG 168 UNITS PER PFS",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7328",
            " Charge Amount ": " $9.39 ",
            " Min Reimb ": " $1.91 ",
            " Max Reimb ": " $6.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90978",
            "Item/Package": "Item",
            "Description": "QUAD FLU VAC 3YR/0.5ML",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "90688",
            " Charge Amount ": " $34.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90987",
            "Item/Package": "Item",
            "Description": "GEL-ONE/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7326",
            " Charge Amount ": " $2,188.00 ",
            " Min Reimb ": " $325.62 ",
            " Max Reimb ": " $1,531.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000008",
            "Item/Package": "Item",
            "Description": "BOTOX INJECTION/1 UNIT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0585",
            " Charge Amount ": " $22.48 ",
            " Min Reimb ": " $5.32 ",
            " Max Reimb ": " $15.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000012",
            "Item/Package": "Item",
            "Description": "FENTANYL CITRATE INJ/.01 MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3010",
            " Charge Amount ": " $2.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000013",
            "Item/Package": "Item",
            "Description": "DUROLANE/1MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7318",
            " Charge Amount ": " $42.20 ",
            " Min Reimb ": " $15.12 ",
            " Max Reimb ": " $29.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000015",
            "Item/Package": "Item",
            "Description": "SYNVISC ONE 48MG/CHG BY 1 MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7325",
            " Charge Amount ": " $52.29 ",
            " Min Reimb ": " $9.37 ",
            " Max Reimb ": " $36.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000016",
            "Item/Package": "Item",
            "Description": "DEXAMETHASONE 1MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1100",
            " Charge Amount ": " $1.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000017",
            "Item/Package": "Item",
            "Description": "CLONIDINE HCL 1 MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0735",
            " Charge Amount ": " $93.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $65.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000018",
            "Item/Package": "Item",
            "Description": "MORPHINE 10 MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2274",
            " Charge Amount ": " $13.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000019",
            "Item/Package": "Item",
            "Description": "BUPIVICANIE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3490",
            " Charge Amount ": " $16.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000020",
            "Item/Package": "Item",
            "Description": "BACLOFEN 10 MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0475",
            " Charge Amount ": " $747.00 ",
            " Min Reimb ": " $151.69 ",
            " Max Reimb ": " $522.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000021",
            "Item/Package": "Item",
            "Description": "HYDROMORPHONE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1170",
            " Charge Amount ": " $542.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $379.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000024",
            "Item/Package": "Item",
            "Description": "TRIAMCINOLONE ACE XR 1MG",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3304",
            " Charge Amount ": " $66.00 ",
            " Min Reimb ": " $15.81 ",
            " Max Reimb ": " $46.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100103",
            "Item/Package": "Item",
            "Description": "Hospital Clinic Visit II",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "G0463",
            " Charge Amount ": " $290.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $203.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100104",
            "Item/Package": "Item",
            "Description": "Hospital Clinic Visit I",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "G0463",
            " Charge Amount ": " $174.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $121.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100600",
            "Item/Package": "Item",
            "Description": "DRAINGE OF SKIN ABSCESS SIMP",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "10060",
            " Charge Amount ": " $880.00 ",
            " Min Reimb ": " $157.64 ",
            " Max Reimb ": " $616.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205260",
            "Item/Package": "Item",
            "Description": "INJ THERA CARPAL TUNNEL LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20526",
            " Charge Amount ": " $683.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $478.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205262",
            "Item/Package": "Item",
            "Description": "INJ THERA CARPAL TUNNEL RT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20526",
            " Charge Amount ": " $683.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $478.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205264",
            "Item/Package": "Item",
            "Description": "INJ THERA CARPAL TUNNEL BL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20526",
            " Charge Amount ": " $1,024.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $716.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205500",
            "Item/Package": "Item",
            "Description": "INJ TRIGGER PT TENDON SHEATH",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20550",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205504",
            "Item/Package": "Item",
            "Description": "INJ TRGGER PT TENDON SHEATH BL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20550",
            " Charge Amount ": " $1,021.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $714.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205510",
            "Item/Package": "Item",
            "Description": "INJ TENDON ORIGIN/INSERTION",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20551",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205520",
            "Item/Package": "Item",
            "Description": "TRIGGER POINT 1-2 MUSC GRPS",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20552",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206000",
            "Item/Package": "Item",
            "Description": "INJ SMALL JNT FINGER/TOE LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20600",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206004",
            "Item/Package": "Item",
            "Description": "INJ SMALL JNT FINGER/TOE BL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20600",
            " Charge Amount ": " $1,588.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $1,111.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206008",
            "Item/Package": "Item",
            "Description": "INJ SMALL JNT FINGER/TOE RT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20600",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206050",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ JOINT/BURSA LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20605",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206054",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ JOINT/BURSA BL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20605",
            " Charge Amount ": " $1,588.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $1,111.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206058",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ JOINT/BURSA RT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20605",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206100",
            "Item/Package": "Item",
            "Description": "ARTHRO MAJOR JOINT/BURSA LT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20610",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206104",
            "Item/Package": "Item",
            "Description": "ARTHRO MAJOR JOINT OR BURSA BL",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20610",
            " Charge Amount ": " $1,588.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $1,111.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206108",
            "Item/Package": "Item",
            "Description": "ARTHRO MAJOR JOINT/BURSA RT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20610",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206120",
            "Item/Package": "Item",
            "Description": "INJ/ASP GANG CYST",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20612",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "243570",
            "Item/Package": "Item",
            "Description": "PERC TENOLYSIS",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "24357",
            " Charge Amount ": " $812.00 ",
            " Min Reimb ": " $1,245.31 ",
            " Max Reimb ": " $568.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "256050",
            "Item/Package": "Item",
            "Description": "TREAT FRACTURE RADIUS/ULNA",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "25605",
            " Charge Amount ": " $1,676.00 ",
            " Min Reimb ": " $324.03 ",
            " Max Reimb ": " $1,173.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "270960",
            "Item/Package": "Item",
            "Description": "INJ PROC SACROILIAC JOINT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "27096",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "290650",
            "Item/Package": "Item",
            "Description": "APPLY LONG ARM CAST",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29065",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "290750",
            "Item/Package": "Item",
            "Description": "APLLY SHORT ARM CAST",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29075",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "290850",
            "Item/Package": "Item",
            "Description": "APLLY GAUNTLET CAST",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29085",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $123.95 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "291050",
            "Item/Package": "Item",
            "Description": "APPLY LONG ARM SPLINT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29105",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "291250",
            "Item/Package": "Item",
            "Description": "APPLY SHORT ARM SPLINT STATIC",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29125",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "291300",
            "Item/Package": "Item",
            "Description": "APPLY FINGER SPLINT STATIC",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29130",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "294050",
            "Item/Package": "Item",
            "Description": "APPLY SH LEG CAST",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29405",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "294250",
            "Item/Package": "Item",
            "Description": "APPLY WLKR SH LEG CAST",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29425",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "295050",
            "Item/Package": "Item",
            "Description": "APPLY LONG LEG SPLINT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29505",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "295150",
            "Item/Package": "Item",
            "Description": "APPLY SHORT LEG SPLINT",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29515",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644500",
            "Item/Package": "Item",
            "Description": "INJ NERVE BLOCK",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "64450",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "963720",
            "Item/Package": "Item",
            "Description": "THER/PROPH/DIAG INJ SC IM",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "96372",
            " Charge Amount ": " $110.00 ",
            " Min Reimb ": " $54.41 ",
            " Max Reimb ": " $77.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "0232T",
            "Item/Package": "Item",
            "Description": "NJX PLATELET PLASMA",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "0232T",
            " Charge Amount ": " $983.00 ",
            " Min Reimb ": " $237.25 ",
            " Max Reimb ": " $688.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "I000000004",
            "Item/Package": "Item",
            "Description": "TREAT METACARPAL FRACTURE",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "26605",
            " Charge Amount ": " $868.00 ",
            " Min Reimb ": " $181.04 ",
            " Max Reimb ": " $607.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "I000000007",
            "Item/Package": "Item",
            "Description": "APPLY LONG LEG CAST",
            "Location": "Southwoods Imaging & Orthopedics - Belmont Ave",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29345",
            " Charge Amount ": " $679.00 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $475.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "700300",
            "Item/Package": "Item",
            "Description": "XR EYE FOREIGN BODY LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70030",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701000",
            "Item/Package": "Item",
            "Description": "XR MANDIBLE LIMITED < 4V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701100",
            "Item/Package": "Item",
            "Description": "XR MANDIBLE COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70110",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701300",
            "Item/Package": "Item",
            "Description": "X-RAY EXAM OF MASTOIDS 3V>",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70130",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701500",
            "Item/Package": "Item",
            "Description": "XR FACIAL BONES > 3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70150",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701600",
            "Item/Package": "Item",
            "Description": "XR NASAL BONE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70160",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701900",
            "Item/Package": "Item",
            "Description": "XR EYE SOCKETS",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70190",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702000",
            "Item/Package": "Item",
            "Description": "XR ORBIT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70200",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702100",
            "Item/Package": "Item",
            "Description": "XR SINUS WATERS VIEW",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70210",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702200",
            "Item/Package": "Item",
            "Description": "XR SINUSES",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70220",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702500",
            "Item/Package": "Item",
            "Description": "XR SKULL < 4 VIEWS",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70250",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702600",
            "Item/Package": "Item",
            "Description": "XR SKULL COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70260",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "703600",
            "Item/Package": "Item",
            "Description": "XR SOFT TISSUE NECK",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70360",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720200",
            "Item/Package": "Item",
            "Description": "XR LUMBAR SPINE 1V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720400",
            "Item/Package": "Item",
            "Description": "XR SPINE CERVICAL 3 V/L",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72040",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720500",
            "Item/Package": "Item",
            "Description": "XR SPINE CERVICAL 4 OR 5 VIEWS",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72050",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720520",
            "Item/Package": "Item",
            "Description": "XR SPINE CERVICAL W FLEX EXTEN",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72052",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720690",
            "Item/Package": "Item",
            "Description": "XR SPINE THORAC SCOLIOSIS",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72069",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720700",
            "Item/Package": "Item",
            "Description": "XR THORACIC SPINE 2 V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72070",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720720",
            "Item/Package": "Item",
            "Description": "XR THORACIC SPINE 3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72072",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720740",
            "Item/Package": "Item",
            "Description": "XR THORAC SPINE 4 V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72074",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720800",
            "Item/Package": "Item",
            "Description": "XR TRUNK SPINE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720900",
            "Item/Package": "Item",
            "Description": "XR TRUNK SPINE 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72090",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721000",
            "Item/Package": "Item",
            "Description": "XR LUMBAR SPINE  2-3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721100",
            "Item/Package": "Item",
            "Description": "XR LOWER SPINE MIN 4V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72110",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721140",
            "Item/Package": "Item",
            "Description": "XR LUMBAR SPINE 6V W BENDING",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72114",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721700",
            "Item/Package": "Item",
            "Description": "XR PELVIS AP VIEW",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72170",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721900",
            "Item/Package": "Item",
            "Description": "XR PELVIS MIN 3 V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72190",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "722000",
            "Item/Package": "Item",
            "Description": "XR SACROILIAC JOINT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72200",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "722020",
            "Item/Package": "Item",
            "Description": "XR SACROILIAC JOINTS",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72202",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "722200",
            "Item/Package": "Item",
            "Description": "XR SACRUM COCYX",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72220",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730000",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE BL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730002",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730003",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE RT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730004",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE BI",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730100",
            "Item/Package": "Item",
            "Description": "XR SCAPULA LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730103",
            "Item/Package": "Item",
            "Description": "XR SCAPULA RT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730104",
            "Item/Package": "Item",
            "Description": "XR SCAPULA BL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730200",
            "Item/Package": "Item",
            "Description": "XR SHOULDER 1V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730202",
            "Item/Package": "Item",
            "Description": "XR SHOULDER LT 1V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730203",
            "Item/Package": "Item",
            "Description": "XR SHOULDER RT 1V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730204",
            "Item/Package": "Item",
            "Description": "XR SHOULDER RT BL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730300",
            "Item/Package": "Item",
            "Description": "XR SHOULDER COMPLETE BL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73030",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730302",
            "Item/Package": "Item",
            "Description": "XR SHOULDER LT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73030",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730303",
            "Item/Package": "Item",
            "Description": "XR SHOULDER RT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73030",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730400",
            "Item/Package": "Item",
            "Description": "XR SHOULDER W CON",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73040",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $201.67 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730500",
            "Item/Package": "Item",
            "Description": "XR SHOULDERS",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73050",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730504",
            "Item/Package": "Item",
            "Description": "XR AC JOINT BI",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73050",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730600",
            "Item/Package": "Item",
            "Description": "XR HUMERUS",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730602",
            "Item/Package": "Item",
            "Description": "XR HUMERUS LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730603",
            "Item/Package": "Item",
            "Description": "XR HUMERUS RT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730604",
            "Item/Package": "Item",
            "Description": "XR HUMERUS BL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730700",
            "Item/Package": "Item",
            "Description": "XR ELBOW BL LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73070",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730702",
            "Item/Package": "Item",
            "Description": "XR ELBOW LT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73070",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730703",
            "Item/Package": "Item",
            "Description": "XR ELBOW RT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73070",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730800",
            "Item/Package": "Item",
            "Description": "XR ELBOW MIN 3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730802",
            "Item/Package": "Item",
            "Description": "XR ELBOW LT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730803",
            "Item/Package": "Item",
            "Description": "XR ELBOW RT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730804",
            "Item/Package": "Item",
            "Description": "XR ELBOW BI COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730900",
            "Item/Package": "Item",
            "Description": "XR EX OF FOREARM 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730902",
            "Item/Package": "Item",
            "Description": "XR FOREARM LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730903",
            "Item/Package": "Item",
            "Description": "XR FOREARM RT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730904",
            "Item/Package": "Item",
            "Description": "XR FOREARM BL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731000",
            "Item/Package": "Item",
            "Description": "XR EXOF WRIST 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731002",
            "Item/Package": "Item",
            "Description": "XR WRIST LT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731003",
            "Item/Package": "Item",
            "Description": "XR WRIST RT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731004",
            "Item/Package": "Item",
            "Description": "XR WRIST BL LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731100",
            "Item/Package": "Item",
            "Description": "XR WRIST BL COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73110",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731102",
            "Item/Package": "Item",
            "Description": "XR WRIST LT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73110",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731103",
            "Item/Package": "Item",
            "Description": "XR WRIST RT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73110",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731200",
            "Item/Package": "Item",
            "Description": "XR HAND 2 VIEWS",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731202",
            "Item/Package": "Item",
            "Description": "XR HAND LT 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731203",
            "Item/Package": "Item",
            "Description": "XR HAND RT 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731204",
            "Item/Package": "Item",
            "Description": "XR HANS BL 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731300",
            "Item/Package": "Item",
            "Description": "XR HAND BL 3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73130",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731302",
            "Item/Package": "Item",
            "Description": "XR HAND LT 3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73130",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731303",
            "Item/Package": "Item",
            "Description": "XR HAND RT 3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73130",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731400",
            "Item/Package": "Item",
            "Description": "XR FINGERS",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73140",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731402",
            "Item/Package": "Item",
            "Description": "XR FINGER LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73140",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731403",
            "Item/Package": "Item",
            "Description": "XR FINGER RT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73140",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735010",
            "Item/Package": "Item",
            "Description": "XR HIP UNI 1V RT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73501",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735012",
            "Item/Package": "Item",
            "Description": "XR HIP UNI 1V LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73501",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735020",
            "Item/Package": "Item",
            "Description": "XR HIP UNI W/PELVIS 2-3/V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73502",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735022",
            "Item/Package": "Item",
            "Description": "XR HIP UNI/PELVIS 2-3V RT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73502",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735023",
            "Item/Package": "Item",
            "Description": "XR HIP UNI/PELVIS 2-3V LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73502",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735210",
            "Item/Package": "Item",
            "Description": "XR Hips BL W/PELVIS 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73521",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735510",
            "Item/Package": "Item",
            "Description": "XR FEMUR 1 V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73551",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735520",
            "Item/Package": "Item",
            "Description": "XR FEMUR 2/> BL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73552",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735522",
            "Item/Package": "Item",
            "Description": "XR FEMUR 2/> RT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73552",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735523",
            "Item/Package": "Item",
            "Description": "XR FEMUR 2/>LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73552",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735600",
            "Item/Package": "Item",
            "Description": "XR KNEE LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735602",
            "Item/Package": "Item",
            "Description": "XR KNEE LT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735603",
            "Item/Package": "Item",
            "Description": "XR KNEE RT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735604",
            "Item/Package": "Item",
            "Description": "XR KNEE BL LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735620",
            "Item/Package": "Item",
            "Description": "XR KNEE 3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735622",
            "Item/Package": "Item",
            "Description": "XR KNEE LT 3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735623",
            "Item/Package": "Item",
            "Description": "XR KNEE RT 3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735624",
            "Item/Package": "Item",
            "Description": "XR KNEE BL 3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735640",
            "Item/Package": "Item",
            "Description": "XR KNEE BL 4V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73564",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735642",
            "Item/Package": "Item",
            "Description": "XR KNEE LT 4V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73564",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735643",
            "Item/Package": "Item",
            "Description": "XR KNEE RT 4V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73564",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735650",
            "Item/Package": "Item",
            "Description": "XR KNEE STANDING AP BL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73565",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735900",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735902",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735903",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA RT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735904",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA BL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736000",
            "Item/Package": "Item",
            "Description": "XR ANKLE LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736002",
            "Item/Package": "Item",
            "Description": "XR ANKLE LT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736003",
            "Item/Package": "Item",
            "Description": "XR ANKLE RT LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736004",
            "Item/Package": "Item",
            "Description": "XR ANKLE BL LIMITED",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736100",
            "Item/Package": "Item",
            "Description": "XR ANKLE BL COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73610",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736102",
            "Item/Package": "Item",
            "Description": "XR ANKLE LT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73610",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736103",
            "Item/Package": "Item",
            "Description": "XR ANKLE RT COMPLETE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73610",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736200",
            "Item/Package": "Item",
            "Description": "XR FOOT 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736202",
            "Item/Package": "Item",
            "Description": "XR FOOT LT 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736203",
            "Item/Package": "Item",
            "Description": "XR FOOT RT 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736204",
            "Item/Package": "Item",
            "Description": "XR FOOT BL 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736300",
            "Item/Package": "Item",
            "Description": "XR FOOT 3 V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736302",
            "Item/Package": "Item",
            "Description": "XR FOOT LT 3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736303",
            "Item/Package": "Item",
            "Description": "XR FOOT RT 3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736304",
            "Item/Package": "Item",
            "Description": "XR FOOT BL 3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736500",
            "Item/Package": "Item",
            "Description": "XR HEEL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736502",
            "Item/Package": "Item",
            "Description": "XR CALCANEUS LT 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736503",
            "Item/Package": "Item",
            "Description": "XR CALCANEUS RT 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736504",
            "Item/Package": "Item",
            "Description": "XR CALCANEUS BI 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736600",
            "Item/Package": "Item",
            "Description": "XR TOES",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73660",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736602",
            "Item/Package": "Item",
            "Description": "XR TOES LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73660",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736603",
            "Item/Package": "Item",
            "Description": "XR TOES RT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73660",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740000",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN 1V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740100",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN W/OBLIQUE/CONE V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740200",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74020",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740220",
            "Item/Package": "Item",
            "Description": "XR SERIES ABDOMEN",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74022",
            " Charge Amount ": " $572.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $400.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "742500",
            "Item/Package": "Item",
            "Description": "XR SMALL BOWEL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74250",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770730",
            "Item/Package": "Item",
            "Description": "XR BONE LENGTH",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "77073",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710100",
            "Item/Package": "Item",
            "Description": "XR CHEST 1V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710200",
            "Item/Package": "Item",
            "Description": "XR CHEST 2V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71020",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710210",
            "Item/Package": "Item",
            "Description": "XR CHEST 2V/APICAL LORDOTI PRO",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71021",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710220",
            "Item/Package": "Item",
            "Description": "XR CHEST 2V W/ OBLIQUE PROJ",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71022",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710300",
            "Item/Package": "Item",
            "Description": "XR CHEST & DECUBITUS VIEWS",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71030",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711000",
            "Item/Package": "Item",
            "Description": "XR RIBS",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71100",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711002",
            "Item/Package": "Item",
            "Description": "XR RIBS LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711003",
            "Item/Package": "Item",
            "Description": "XR RIBS RT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71100",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711010",
            "Item/Package": "Item",
            "Description": "XR RIBS CHEST",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71101",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711100",
            "Item/Package": "Item",
            "Description": "XR RIBS BL 3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71110",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711110",
            "Item/Package": "Item",
            "Description": "XR RIBS CHEST,POSTEROANTER 4V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71111",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711114",
            "Item/Package": "Item",
            "Description": "XR RIBS BI",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71111",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711200",
            "Item/Package": "Item",
            "Description": "XR STERNUM",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71120",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711300",
            "Item/Package": "Item",
            "Description": "XR BREASTBONE 3V",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71130",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90479",
            "Item/Package": "Item",
            "Description": "DEPOMEDROL METHYLPRED 80MG/ML",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1040",
            " Charge Amount ": " $86.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $60.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90902",
            "Item/Package": "Item",
            "Description": "CELESTONE 6MG/ML 5ML VIAL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0702",
            " Charge Amount ": " $35.15 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $24.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90923",
            "Item/Package": "Item",
            "Description": "SYNVISC 16 MG SYRINGE/ I MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7325",
            " Charge Amount ": " $76.41 ",
            " Min Reimb ": " $9.37 ",
            " Max Reimb ": " $53.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90924",
            "Item/Package": "Item",
            "Description": "KENALOG VIAL/10 MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3301",
            " Charge Amount ": " $11.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $7.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90926",
            "Item/Package": "Item",
            "Description": "HYALGAN/SUPARTZ/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7321",
            " Charge Amount ": " $436.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $305.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90927",
            "Item/Package": "Item",
            "Description": "EUFLEXXA/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7323",
            " Charge Amount ": " $969.60 ",
            " Min Reimb ": " $55.25 ",
            " Max Reimb ": " $678.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90928",
            "Item/Package": "Item",
            "Description": "ORTHOVISC/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7324",
            " Charge Amount ": " $899.40 ",
            " Min Reimb ": " $55.25 ",
            " Max Reimb ": " $629.58 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90929",
            "Item/Package": "Item",
            "Description": "SYNVISC ONE 48 MG1 1 MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7325",
            " Charge Amount ": " $52.29 ",
            " Min Reimb ": " $9.37 ",
            " Max Reimb ": " $36.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90930",
            "Item/Package": "Item",
            "Description": "GEL ONE/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7326",
            " Charge Amount ": " $2,188.00 ",
            " Min Reimb ": " $325.62 ",
            " Max Reimb ": " $1,531.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90931",
            "Item/Package": "Item",
            "Description": "MONOVISC/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7327",
            " Charge Amount ": " $2,426.00 ",
            " Min Reimb ": " $593.50 ",
            " Max Reimb ": " $1,698.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90932",
            "Item/Package": "Item",
            "Description": "GELSYN/16.8 MG/.1 MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7328",
            " Charge Amount ": " $9.39 ",
            " Min Reimb ": " $1.91 ",
            " Max Reimb ": " $6.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90933",
            "Item/Package": "Item",
            "Description": "ABATACEPT 10MG/10MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0129",
            " Charge Amount ": " $91.00 ",
            " Min Reimb ": " $49.93 ",
            " Max Reimb ": " $63.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90934",
            "Item/Package": "Item",
            "Description": "BELIMUMAB 120 MG/10MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0490",
            " Charge Amount ": " $78.00 ",
            " Min Reimb ": " $41.12 ",
            " Max Reimb ": " $54.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90936",
            "Item/Package": "Item",
            "Description": "BETAMETHA. AC & PHOS 3MG/3MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0702",
            " Charge Amount ": " $13.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90937",
            "Item/Package": "Item",
            "Description": "CERTOLIZUMAB PEGOL 1MG/1MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0717",
            " Charge Amount ": " $14.00 ",
            " Min Reimb ": " $7.18 ",
            " Max Reimb ": " $9.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90939",
            "Item/Package": "Item",
            "Description": "DEPO MEDROL 20MG/20 MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1020",
            " Charge Amount ": " $22.02 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $15.41 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90940",
            "Item/Package": "Item",
            "Description": "DEPO MEDROL 40 MG/40MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1030",
            " Charge Amount ": " $42.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $29.53 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90941",
            "Item/Package": "Item",
            "Description": "DEPO MEDROL 80MG/80 MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1040",
            " Charge Amount ": " $86.42 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $60.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90942",
            "Item/Package": "Item",
            "Description": "GOLIMUMAB IV 1MG/1MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1602",
            " Charge Amount ": " $41.00 ",
            " Min Reimb ": " $15.92 ",
            " Max Reimb ": " $28.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90943",
            "Item/Package": "Item",
            "Description": "INFLIXIMAB 10MG/10MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1745",
            " Charge Amount ": " $135.00 ",
            " Min Reimb ": " $39.43 ",
            " Max Reimb ": " $94.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90944",
            "Item/Package": "Item",
            "Description": "TORADOL 15 MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1885",
            " Charge Amount ": " $5.49 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3.84 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90946",
            "Item/Package": "Item",
            "Description": "SOLU MEDROL 125MG/125MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2930",
            " Charge Amount ": " $13.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90947",
            "Item/Package": "Item",
            "Description": "ACTEMRA 80MG/1MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3262",
            " Charge Amount ": " $9.00 ",
            " Min Reimb ": " $4.80 ",
            " Max Reimb ": " $6.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90949",
            "Item/Package": "Item",
            "Description": "ACTEMRA 400MG/1MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3262",
            " Charge Amount ": " $9.00 ",
            " Min Reimb ": " $4.80 ",
            " Max Reimb ": " $6.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90950",
            "Item/Package": "Item",
            "Description": "KENALOG 10MG/10 MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3301",
            " Charge Amount ": " $3.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90951",
            "Item/Package": "Item",
            "Description": "VIT B-12 INJ 1000MCG/1000MCG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3420",
            " Charge Amount ": " $13.85 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.69 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90952",
            "Item/Package": "Item",
            "Description": "ZOLEDRONIC ACID 1MG/1MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3489",
            " Charge Amount ": " $74.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $51.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90954",
            "Item/Package": "Item",
            "Description": "SUPARTZ/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7321",
            " Charge Amount ": " $436.80 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $305.76 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90955",
            "Item/Package": "Item",
            "Description": "EUFLEXXA/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7323",
            " Charge Amount ": " $969.60 ",
            " Min Reimb ": " $55.25 ",
            " Max Reimb ": " $678.72 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90956",
            "Item/Package": "Item",
            "Description": "BUPIVACAINE HCL/PF 7.5MG/ML 30",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7324",
            " Charge Amount ": " $299.00 ",
            " Min Reimb ": " $55.25 ",
            " Max Reimb ": " $209.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90959",
            "Item/Package": "Item",
            "Description": "MONOVISC/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7327",
            " Charge Amount ": " $2,426.00 ",
            " Min Reimb ": " $593.50 ",
            " Max Reimb ": " $1,698.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90960",
            "Item/Package": "Item",
            "Description": "GELSYN-3/CHG 168 UNITS PER PFS",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7328",
            " Charge Amount ": " $9.39 ",
            " Min Reimb ": " $1.91 ",
            " Max Reimb ": " $6.57 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90978",
            "Item/Package": "Item",
            "Description": "QUAD FLU VAC 3YR/0.5ML",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "90688",
            " Charge Amount ": " $34.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90987",
            "Item/Package": "Item",
            "Description": "GEL-ONE/DOSE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7326",
            " Charge Amount ": " $2,188.00 ",
            " Min Reimb ": " $325.62 ",
            " Max Reimb ": " $1,531.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000008",
            "Item/Package": "Item",
            "Description": "BOTOX INJECTION/1 UNIT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0585",
            " Charge Amount ": " $22.48 ",
            " Min Reimb ": " $5.32 ",
            " Max Reimb ": " $15.74 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000012",
            "Item/Package": "Item",
            "Description": "FENTANYL CITRATE INJ/.01 MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3010",
            " Charge Amount ": " $2.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000013",
            "Item/Package": "Item",
            "Description": "DUROLANE/1MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7318",
            " Charge Amount ": " $42.20 ",
            " Min Reimb ": " $15.12 ",
            " Max Reimb ": " $29.54 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000015",
            "Item/Package": "Item",
            "Description": "SYNVISC ONE 48MG/CHG BY 1 MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J7325",
            " Charge Amount ": " $52.29 ",
            " Min Reimb ": " $9.37 ",
            " Max Reimb ": " $36.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000016",
            "Item/Package": "Item",
            "Description": "DEXAMETHASONE 1MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1100",
            " Charge Amount ": " $1.69 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $1.18 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000017",
            "Item/Package": "Item",
            "Description": "CLONIDINE HCL 1 MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0735",
            " Charge Amount ": " $93.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $65.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000018",
            "Item/Package": "Item",
            "Description": "MORPHINE 10 MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2274",
            " Charge Amount ": " $13.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000019",
            "Item/Package": "Item",
            "Description": "BUPIVICANIE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3490",
            " Charge Amount ": " $16.66 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $11.66 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000020",
            "Item/Package": "Item",
            "Description": "BACLOFEN 10 MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0475",
            " Charge Amount ": " $747.00 ",
            " Min Reimb ": " $151.69 ",
            " Max Reimb ": " $522.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000021",
            "Item/Package": "Item",
            "Description": "HYDROMORPHONE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1170",
            " Charge Amount ": " $542.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $379.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "D000000024",
            "Item/Package": "Item",
            "Description": "TRIAMCINOLONE ACE XR 1MG",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3304",
            " Charge Amount ": " $66.00 ",
            " Min Reimb ": " $15.81 ",
            " Max Reimb ": " $46.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100103",
            "Item/Package": "Item",
            "Description": "Hospital Clinic Visit II",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "G0463",
            " Charge Amount ": " $290.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $203.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100104",
            "Item/Package": "Item",
            "Description": "Hospital Clinic Visit I",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "G0463",
            " Charge Amount ": " $174.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $121.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100600",
            "Item/Package": "Item",
            "Description": "DRAINGE OF SKIN ABSCESS SIMP",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "10060",
            " Charge Amount ": " $880.00 ",
            " Min Reimb ": " $157.64 ",
            " Max Reimb ": " $616.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205260",
            "Item/Package": "Item",
            "Description": "INJ THERA CARPAL TUNNEL LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20526",
            " Charge Amount ": " $683.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $478.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205262",
            "Item/Package": "Item",
            "Description": "INJ THERA CARPAL TUNNEL RT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20526",
            " Charge Amount ": " $683.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $478.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205264",
            "Item/Package": "Item",
            "Description": "INJ THERA CARPAL TUNNEL BL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20526",
            " Charge Amount ": " $1,024.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $716.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205500",
            "Item/Package": "Item",
            "Description": "INJ TRIGGER PT TENDON SHEATH",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20550",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205504",
            "Item/Package": "Item",
            "Description": "INJ TRGGER PT TENDON SHEATH BL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20550",
            " Charge Amount ": " $1,021.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $714.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205510",
            "Item/Package": "Item",
            "Description": "INJ TENDON ORIGIN/INSERTION",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20551",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "205520",
            "Item/Package": "Item",
            "Description": "TRIGGER POINT 1-2 MUSC GRPS",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20552",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206000",
            "Item/Package": "Item",
            "Description": "INJ SMALL JNT FINGER/TOE LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20600",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206004",
            "Item/Package": "Item",
            "Description": "INJ SMALL JNT FINGER/TOE BL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20600",
            " Charge Amount ": " $1,588.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $1,111.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206008",
            "Item/Package": "Item",
            "Description": "INJ SMALL JNT FINGER/TOE RT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20600",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206050",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ JOINT/BURSA LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20605",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206054",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ JOINT/BURSA BL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20605",
            " Charge Amount ": " $1,588.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $1,111.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206058",
            "Item/Package": "Item",
            "Description": "DRAIN/INJ JOINT/BURSA RT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20605",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206100",
            "Item/Package": "Item",
            "Description": "ARTHRO MAJOR JOINT/BURSA LT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20610",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206104",
            "Item/Package": "Item",
            "Description": "ARTHRO MAJOR JOINT OR BURSA BL",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20610",
            " Charge Amount ": " $1,588.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $1,111.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206108",
            "Item/Package": "Item",
            "Description": "ARTHRO MAJOR JOINT/BURSA RT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20610",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "206120",
            "Item/Package": "Item",
            "Description": "INJ/ASP GANG CYST",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "20612",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $210.37 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "243570",
            "Item/Package": "Item",
            "Description": "PERC TENOLYSIS",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "24357",
            " Charge Amount ": " $812.00 ",
            " Min Reimb ": " $1,245.31 ",
            " Max Reimb ": " $568.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "256050",
            "Item/Package": "Item",
            "Description": "TREAT FRACTURE RADIUS/ULNA",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "25605",
            " Charge Amount ": " $1,676.00 ",
            " Min Reimb ": " $324.03 ",
            " Max Reimb ": " $1,173.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "270960",
            "Item/Package": "Item",
            "Description": "INJ PROC SACROILIAC JOINT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "27096",
            " Charge Amount ": " $3,188.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $2,231.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "290650",
            "Item/Package": "Item",
            "Description": "APPLY LONG ARM CAST",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29065",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "290750",
            "Item/Package": "Item",
            "Description": "APLLY SHORT ARM CAST",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29075",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "290850",
            "Item/Package": "Item",
            "Description": "APLLY GAUNTLET CAST",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29085",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $123.95 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "291050",
            "Item/Package": "Item",
            "Description": "APPLY LONG ARM SPLINT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29105",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "291250",
            "Item/Package": "Item",
            "Description": "APPLY SHORT ARM SPLINT STATIC",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29125",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "291300",
            "Item/Package": "Item",
            "Description": "APPLY FINGER SPLINT STATIC",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29130",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "294050",
            "Item/Package": "Item",
            "Description": "APPLY SH LEG CAST",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29405",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "294250",
            "Item/Package": "Item",
            "Description": "APPLY WLKR SH LEG CAST",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29425",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "295050",
            "Item/Package": "Item",
            "Description": "APPLY LONG LEG SPLINT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29505",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "295150",
            "Item/Package": "Item",
            "Description": "APPLY SHORT LEG SPLINT",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29515",
            " Charge Amount ": " $682.00 ",
            " Min Reimb ": " $91.92 ",
            " Max Reimb ": " $477.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "644500",
            "Item/Package": "Item",
            "Description": "INJ NERVE BLOCK",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "64450",
            " Charge Amount ": " $1,059.00 ",
            " Min Reimb ": " $313.84 ",
            " Max Reimb ": " $741.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "963720",
            "Item/Package": "Item",
            "Description": "THER/PROPH/DIAG INJ SC IM",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "96372",
            " Charge Amount ": " $110.00 ",
            " Min Reimb ": " $54.41 ",
            " Max Reimb ": " $77.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "0232T",
            "Item/Package": "Item",
            "Description": "NJX PLATELET PLASMA",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "0232T",
            " Charge Amount ": " $983.00 ",
            " Min Reimb ": " $237.25 ",
            " Max Reimb ": " $688.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "I000000004",
            "Item/Package": "Item",
            "Description": "TREAT METACARPAL FRACTURE",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "26605",
            " Charge Amount ": " $868.00 ",
            " Min Reimb ": " $181.04 ",
            " Max Reimb ": " $607.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "I000000007",
            "Item/Package": "Item",
            "Description": "APPLY LONG LEG CAST",
            "Location": "Southwoods Imaging & Orthopedics - Calcutta",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "29345",
            " Charge Amount ": " $679.00 ",
            " Min Reimb ": " $172.06 ",
            " Max Reimb ": " $475.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "700300",
            "Item/Package": "Item",
            "Description": "XR EYE FOREIGN BODY LT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70030",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701000",
            "Item/Package": "Item",
            "Description": "XR MANDIBLE LIMITED < 4V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701100",
            "Item/Package": "Item",
            "Description": "XR MANDIBLE COMPLETE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70110",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701300",
            "Item/Package": "Item",
            "Description": "X-RAY EXAM OF MASTOIDS 3V>",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70130",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701500",
            "Item/Package": "Item",
            "Description": "XR FACIAL BONES > 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70150",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701600",
            "Item/Package": "Item",
            "Description": "XR NASAL BONE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70160",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "701900",
            "Item/Package": "Item",
            "Description": "XR EYE SOCKETS",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70190",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702000",
            "Item/Package": "Item",
            "Description": "XR ORBIT COMPLETE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70200",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702100",
            "Item/Package": "Item",
            "Description": "XR SINUS WATERS VIEW",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70210",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702200",
            "Item/Package": "Item",
            "Description": "XR SINUSES",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70220",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702500",
            "Item/Package": "Item",
            "Description": "XR SKULL < 4 VIEWS",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70250",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "702600",
            "Item/Package": "Item",
            "Description": "XR SKULL COMPLETE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70260",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "703300",
            "Item/Package": "Item",
            "Description": "XR JAW JOINTS",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70330",
            " Charge Amount ": " $594.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $415.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "703600",
            "Item/Package": "Item",
            "Description": "XR SOFT TISSUE NECK",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "70360",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710100",
            "Item/Package": "Item",
            "Description": "XR CHEST 1V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710200",
            "Item/Package": "Item",
            "Description": "XR CHEST 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71020",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710210",
            "Item/Package": "Item",
            "Description": "XR CHEST 2V/APICAL LORDOTI PRO",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71021",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710220",
            "Item/Package": "Item",
            "Description": "XR CHEST 2V W/ OBLIQUE PROJ",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71022",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710300",
            "Item/Package": "Item",
            "Description": "XR CHEST & DECUBITUS VIEWS",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71030",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710450",
            "Item/Package": "Item",
            "Description": "XR CHEST 1V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71045",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710460",
            "Item/Package": "Item",
            "Description": "XR CHEST 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71046",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710470",
            "Item/Package": "Item",
            "Description": "XR CHEST 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71047",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "710480",
            "Item/Package": "Item",
            "Description": "XR CHEST 4+V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71048",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711000",
            "Item/Package": "Item",
            "Description": "XR RIBS",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71100",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711002",
            "Item/Package": "Item",
            "Description": "XR RIBS LT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711003",
            "Item/Package": "Item",
            "Description": "XR RIBS RT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71100",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711010",
            "Item/Package": "Item",
            "Description": "XR RIBS CHEST",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71101",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711100",
            "Item/Package": "Item",
            "Description": "XR RIBS BL 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71110",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711110",
            "Item/Package": "Item",
            "Description": "XR RIBS CHEST,POSTEROANTER 4V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71111",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711114",
            "Item/Package": "Item",
            "Description": "XR RIBS BI",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71111",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711200",
            "Item/Package": "Item",
            "Description": "XR STERNUM",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71120",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "711300",
            "Item/Package": "Item",
            "Description": "XR BREASTBONE 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "324",
            "CPT/HCPCS/DRG": "71130",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720200",
            "Item/Package": "Item",
            "Description": "XR LUMBAR SPINE 1V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720400",
            "Item/Package": "Item",
            "Description": "XR SPINE CERVICAL 3 V/L",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72040",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720500",
            "Item/Package": "Item",
            "Description": "XR SPINE CERVICAL 4 OR 5 VIEWS",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72050",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720520",
            "Item/Package": "Item",
            "Description": "XR SPINE CERVICAL W FLEX EXTEN",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72052",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720690",
            "Item/Package": "Item",
            "Description": "XR SPINE THORAC SCOLIOSIS",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72069",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720700",
            "Item/Package": "Item",
            "Description": "XR THORACIC SPINE 2 V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72070",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720720",
            "Item/Package": "Item",
            "Description": "XR THORACIC SPINE 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72072",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720740",
            "Item/Package": "Item",
            "Description": "XR THORAC SPINE 4 V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72074",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720800",
            "Item/Package": "Item",
            "Description": "XR TRUNK SPINE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "720900",
            "Item/Package": "Item",
            "Description": "XR TRUNK SPINE 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72090",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721000",
            "Item/Package": "Item",
            "Description": "XR LUMBAR SPINE  2-3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721100",
            "Item/Package": "Item",
            "Description": "XR LOWER SPINE MIN 4V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72110",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721140",
            "Item/Package": "Item",
            "Description": "XR LUMBAR SPINE 6V W BENDING",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72114",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721700",
            "Item/Package": "Item",
            "Description": "XR PELVIS AP VIEW",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72170",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "721900",
            "Item/Package": "Item",
            "Description": "XR PELVIS MIN 3 V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72190",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "722000",
            "Item/Package": "Item",
            "Description": "XR SACROILIAC JOINT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72200",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "722020",
            "Item/Package": "Item",
            "Description": "XR SACROILIAC JOINTS",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72202",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "722200",
            "Item/Package": "Item",
            "Description": "XR SACRUM COCYX",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "72220",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730000",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE BL",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730002",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE LT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730003",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE RT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730004",
            "Item/Package": "Item",
            "Description": "XR CLAVICLE BI",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730100",
            "Item/Package": "Item",
            "Description": "XR SCAPULA LT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730102",
            "Item/Package": "Item",
            "Description": "XR SCAPULA LT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730103",
            "Item/Package": "Item",
            "Description": "XR SCAPULA RT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730104",
            "Item/Package": "Item",
            "Description": "XR SCAPULA BL",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730200",
            "Item/Package": "Item",
            "Description": "XR SHOULDER 1V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730202",
            "Item/Package": "Item",
            "Description": "XR SHOULDER LT 1V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730203",
            "Item/Package": "Item",
            "Description": "XR SHOULDER RT 1V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730204",
            "Item/Package": "Item",
            "Description": "XR SHOULDER RT BL",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73020",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730300",
            "Item/Package": "Item",
            "Description": "XR SHOULDER COMPLETE BL",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73030",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730302",
            "Item/Package": "Item",
            "Description": "XR SHOULDER LT COMPLETE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73030",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730303",
            "Item/Package": "Item",
            "Description": "XR SHOULDER RT COMPLETE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73030",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730400",
            "Item/Package": "Item",
            "Description": "XR SHOULDER W CON",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73040",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $201.67 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730500",
            "Item/Package": "Item",
            "Description": "XR SHOULDERS",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73050",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730502",
            "Item/Package": "Item",
            "Description": "XR AC JOINT LT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73050",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730503",
            "Item/Package": "Item",
            "Description": "XR AC JOINT RT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73050",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730504",
            "Item/Package": "Item",
            "Description": "XR AC JOINT BI",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73050",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730600",
            "Item/Package": "Item",
            "Description": "XR HUMERUS",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730602",
            "Item/Package": "Item",
            "Description": "XR HUMERUS LT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730603",
            "Item/Package": "Item",
            "Description": "XR HUMERUS RT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730604",
            "Item/Package": "Item",
            "Description": "XR HUMERUS BL",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73060",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730700",
            "Item/Package": "Item",
            "Description": "XR ELBOW BL LIMITED",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73070",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730702",
            "Item/Package": "Item",
            "Description": "XR ELBOW LT LIMITED",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73070",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730703",
            "Item/Package": "Item",
            "Description": "XR ELBOW RT LIMITED",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73070",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730800",
            "Item/Package": "Item",
            "Description": "XR ELBOW MIN 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730802",
            "Item/Package": "Item",
            "Description": "XR ELBOW LT COMPLETE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730803",
            "Item/Package": "Item",
            "Description": "XR ELBOW RT COMPLETE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730804",
            "Item/Package": "Item",
            "Description": "XR ELBOW BI COMPLETE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73080",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730900",
            "Item/Package": "Item",
            "Description": "XR EX OF FOREARM 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730902",
            "Item/Package": "Item",
            "Description": "XR FOREARM LT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730903",
            "Item/Package": "Item",
            "Description": "XR FOREARM RT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "730904",
            "Item/Package": "Item",
            "Description": "XR FOREARM BL",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73090",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731000",
            "Item/Package": "Item",
            "Description": "XR EXOF WRIST 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731002",
            "Item/Package": "Item",
            "Description": "XR WRIST LT LIMITED",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731003",
            "Item/Package": "Item",
            "Description": "XR WRIST RT LIMITED",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731004",
            "Item/Package": "Item",
            "Description": "XR WRIST BL LIMITED",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73100",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731100",
            "Item/Package": "Item",
            "Description": "XR WRIST BL COMPLETE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73110",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731102",
            "Item/Package": "Item",
            "Description": "XR WRIST LT COMPLETE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73110",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731103",
            "Item/Package": "Item",
            "Description": "XR WRIST RT COMPLETE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73110",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731200",
            "Item/Package": "Item",
            "Description": "XR HAND 2 VIEWS",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731202",
            "Item/Package": "Item",
            "Description": "XR HAND LT 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731203",
            "Item/Package": "Item",
            "Description": "XR HAND RT 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731204",
            "Item/Package": "Item",
            "Description": "XR HANS BL 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73120",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731300",
            "Item/Package": "Item",
            "Description": "XR HAND BL 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73130",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731302",
            "Item/Package": "Item",
            "Description": "XR HAND LT 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73130",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731303",
            "Item/Package": "Item",
            "Description": "XR HAND RT 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73130",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731400",
            "Item/Package": "Item",
            "Description": "XR FINGERS",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73140",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731402",
            "Item/Package": "Item",
            "Description": "XR FINGER LT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73140",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "731403",
            "Item/Package": "Item",
            "Description": "XR FINGER RT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73140",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735010",
            "Item/Package": "Item",
            "Description": "XR HIP UNI 1V RT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73501",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735012",
            "Item/Package": "Item",
            "Description": "XR HIP UNI 1V LT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73501",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735020",
            "Item/Package": "Item",
            "Description": "XR HIP UNI W/PELVIS 2-3/V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73502",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735022",
            "Item/Package": "Item",
            "Description": "XR HIP UNI/PELVIS 2-3V RT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73502",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735023",
            "Item/Package": "Item",
            "Description": "XR HIP UNI/PELVIS 2-3V LT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73502",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735210",
            "Item/Package": "Item",
            "Description": "XR Hips BL W/PELVIS 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73521",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735510",
            "Item/Package": "Item",
            "Description": "XR FEMUR 1 V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73551",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735520",
            "Item/Package": "Item",
            "Description": "XR FEMUR 2/> BL",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73552",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735522",
            "Item/Package": "Item",
            "Description": "XR FEMUR 2/> RT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73552",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735523",
            "Item/Package": "Item",
            "Description": "XR FEMUR 2/>LT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73552",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735600",
            "Item/Package": "Item",
            "Description": "XR KNEE LIMITED",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735602",
            "Item/Package": "Item",
            "Description": "XR KNEE LT LIMITED",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735603",
            "Item/Package": "Item",
            "Description": "XR KNEE RT LIMITED",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735604",
            "Item/Package": "Item",
            "Description": "XR KNEE BL LIMITED",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73560",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735620",
            "Item/Package": "Item",
            "Description": "XR KNEE 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735622",
            "Item/Package": "Item",
            "Description": "XR KNEE LT 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735623",
            "Item/Package": "Item",
            "Description": "XR KNEE RT 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735624",
            "Item/Package": "Item",
            "Description": "XR KNEE BL 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73562",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735640",
            "Item/Package": "Item",
            "Description": "XR KNEE BL 4V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73564",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735642",
            "Item/Package": "Item",
            "Description": "XR KNEE LT 4V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73564",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735643",
            "Item/Package": "Item",
            "Description": "XR KNEE RT 4V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73564",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735650",
            "Item/Package": "Item",
            "Description": "XR KNEE STANDING AP BL",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73565",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735900",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735902",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA LT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735903",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA RT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "735904",
            "Item/Package": "Item",
            "Description": "XR TIBIA FIBULA BL",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73590",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736000",
            "Item/Package": "Item",
            "Description": "XR ANKLE LIMITED",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736002",
            "Item/Package": "Item",
            "Description": "XR ANKLE LT LIMITED",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736003",
            "Item/Package": "Item",
            "Description": "XR ANKLE RT LIMITED",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736004",
            "Item/Package": "Item",
            "Description": "XR ANKLE BL LIMITED",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73600",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736100",
            "Item/Package": "Item",
            "Description": "XR ANKLE BL COMPLETE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73610",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736102",
            "Item/Package": "Item",
            "Description": "XR ANKLE LT COMPLETE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73610",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736103",
            "Item/Package": "Item",
            "Description": "XR ANKLE RT COMPLETE",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73610",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736200",
            "Item/Package": "Item",
            "Description": "XR FOOT 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736202",
            "Item/Package": "Item",
            "Description": "XR FOOT LT 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736203",
            "Item/Package": "Item",
            "Description": "XR FOOT RT 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736204",
            "Item/Package": "Item",
            "Description": "XR FOOT BL 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73620",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736300",
            "Item/Package": "Item",
            "Description": "XR FOOT 3 V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736302",
            "Item/Package": "Item",
            "Description": "XR FOOT LT 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736303",
            "Item/Package": "Item",
            "Description": "XR FOOT RT 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736304",
            "Item/Package": "Item",
            "Description": "XR FOOT BL 3V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73630",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736500",
            "Item/Package": "Item",
            "Description": "XR HEEL",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736502",
            "Item/Package": "Item",
            "Description": "XR CALCANEUS LT 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736503",
            "Item/Package": "Item",
            "Description": "XR CALCANEUS RT 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736504",
            "Item/Package": "Item",
            "Description": "XR CALCANEUS BI 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73650",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736600",
            "Item/Package": "Item",
            "Description": "XR TOES",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73660",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736602",
            "Item/Package": "Item",
            "Description": "XR TOES LT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73660",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "736603",
            "Item/Package": "Item",
            "Description": "XR TOES RT",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "73660",
            " Charge Amount ": " $530.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $371.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740000",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN 1V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74000",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740100",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN W/OBLIQUE/CONE V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74010",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740180",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN 1V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74018",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $71.03 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740190",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74019",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740200",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN 2V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74020",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $99.10 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740210",
            "Item/Package": "Item",
            "Description": "XR ABDOMEN 3+V",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74021",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "740220",
            "Item/Package": "Item",
            "Description": "XR SERIES ABDOMEN",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74022",
            " Charge Amount ": " $572.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $400.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "742500",
            "Item/Package": "Item",
            "Description": "XR SMALL BOWEL",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "74250",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $156.76 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "770730",
            "Item/Package": "Item",
            "Description": "XR BONE LENGTH",
            "Location": "Southwoods Imaging - Austintown",
            "Revenue Code": "320",
            "CPT/HCPCS/DRG": "77073",
            " Charge Amount ": " $612.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $428.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9957",
            "Item/Package": "Item",
            "Description": "HC ELECTRODES EKG FOAM SIDEGEL",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9958",
            "Item/Package": "Item",
            "Description": "HC ANGIOCATH SAF-T-INTIMA 24G",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $-   ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $-   ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "9961",
            "Item/Package": "Item",
            "Description": "HC CANNULA LCKING LEVER 15G LF",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "270",
            "CPT/HCPCS/DRG": "NULL",
            " Charge Amount ": " $7.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "856100",
            "Item/Package": "Item",
            "Description": "PROTHROMBIN TIME",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "300",
            "CPT/HCPCS/DRG": "85610",
            " Charge Amount ": " $33.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "784520",
            "Item/Package": "Item",
            "Description": "HEART SCAN SPEC MULTI",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78452",
            " Charge Amount ": " $4,996.00 ",
            " Min Reimb ": " $571.20 ",
            " Max Reimb ": " $3,497.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "784720",
            "Item/Package": "Item",
            "Description": "NM MUGA SGL W WM & EF",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78472",
            " Charge Amount ": " $2,268.00 ",
            " Min Reimb ": " $250.12 ",
            " Max Reimb ": " $1,587.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "784730",
            "Item/Package": "Item",
            "Description": "MUGA MULTI W WM & EF",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "341",
            "CPT/HCPCS/DRG": "78473",
            " Charge Amount ": " $2,797.00 ",
            " Min Reimb ": " $250.12 ",
            " Max Reimb ": " $1,957.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90753",
            "Item/Package": "Item",
            "Description": "TC99M SESTAMIBI = < 20 MCI",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "343",
            "CPT/HCPCS/DRG": "A9500",
            " Charge Amount ": " $556.50 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $389.55 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90755",
            "Item/Package": "Item",
            "Description": "TC99M PERTECHNETATE PER 1 MCI",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "343",
            "CPT/HCPCS/DRG": "A9512",
            " Charge Amount ": " $6.36 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $4.45 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90759",
            "Item/Package": "Item",
            "Description": "TC99M PYROPHOSPHATE =< 25 MCI",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "343",
            "CPT/HCPCS/DRG": "A9538",
            " Charge Amount ": " $268.18 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $187.73 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90852",
            "Item/Package": "Item",
            "Description": "TECHNITEUM 99 RBC",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "343",
            "CPT/HCPCS/DRG": "A9560",
            " Charge Amount ": " $4,403.24 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $3,082.27 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90891",
            "Item/Package": "Item",
            "Description": "THALLIUM PER MCI",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "343",
            "CPT/HCPCS/DRG": "A9505",
            " Charge Amount ": " $133.56 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $93.49 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "932790",
            "Item/Package": "Item",
            "Description": "PM DEVICE PROG EVAL SNGL",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "480",
            "CPT/HCPCS/DRG": "93279",
            " Charge Amount ": " $285.00 ",
            " Min Reimb ": " $32.61 ",
            " Max Reimb ": " $199.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "932800",
            "Item/Package": "Item",
            "Description": "PM DEVICE PROG EVAL DUAL",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "480",
            "CPT/HCPCS/DRG": "93280",
            " Charge Amount ": " $290.00 ",
            " Min Reimb ": " $32.61 ",
            " Max Reimb ": " $203.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "932810",
            "Item/Package": "Item",
            "Description": "PM DEVICE PROG EVAL MULTI",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "480",
            "CPT/HCPCS/DRG": "93281",
            " Charge Amount ": " $302.00 ",
            " Min Reimb ": " $32.61 ",
            " Max Reimb ": " $211.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "932910",
            "Item/Package": "Item",
            "Description": "ILR DEVICE INTERROGATE",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "480",
            "CPT/HCPCS/DRG": "93291",
            " Charge Amount ": " $366.00 ",
            " Min Reimb ": " $21.66 ",
            " Max Reimb ": " $256.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "932930",
            "Item/Package": "Item",
            "Description": "PM PHONE EVAL",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "480",
            "CPT/HCPCS/DRG": "93293",
            " Charge Amount ": " $290.00 ",
            " Min Reimb ": " $32.61 ",
            " Max Reimb ": " $203.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "932960",
            "Item/Package": "Item",
            "Description": "PM/ICD REMOTE TECH SVC",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "480",
            "CPT/HCPCS/DRG": "93296",
            " Charge Amount ": " $434.00 ",
            " Min Reimb ": " $32.61 ",
            " Max Reimb ": " $303.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "I000000012",
            "Item/Package": "Item",
            "Description": "INTER DEVC REMOTE",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "480",
            "CPT/HCPCS/DRG": "G2066",
            " Charge Amount ": " $435.00 ",
            " Min Reimb ": " $32.61 ",
            " Max Reimb ": " $304.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "930170",
            "Item/Package": "Item",
            "Description": "TREADMILL STRESS",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "482",
            "CPT/HCPCS/DRG": "93017",
            " Charge Amount ": " $1,548.00 ",
            " Min Reimb ": " $160.70 ",
            " Max Reimb ": " $1,083.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100097",
            "Item/Package": "Item",
            "Description": "TTE w/wo fol w con doppler",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "483",
            "CPT/HCPCS/DRG": "C8929",
            " Charge Amount ": " $4,220.00 ",
            " Min Reimb ": " $370.53 ",
            " Max Reimb ": " $2,954.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "933060",
            "Item/Package": "Item",
            "Description": "ECHOCARDIOGRAPHY COMPLETE",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "483",
            "CPT/HCPCS/DRG": "93306",
            " Charge Amount ": " $3,753.00 ",
            " Min Reimb ": " $370.53 ",
            " Max Reimb ": " $2,627.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "933070",
            "Item/Package": "Item",
            "Description": "ECHOCARDIOGRAPHY W/O DOPPLER",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "483",
            "CPT/HCPCS/DRG": "93306",
            " Charge Amount ": " $2,896.00 ",
            " Min Reimb ": " $370.53 ",
            " Max Reimb ": " $2,027.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "933080",
            "Item/Package": "Item",
            "Description": "ECHOCARDIOGRAPHY LIMITED",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "483",
            "CPT/HCPCS/DRG": "93308",
            " Charge Amount ": " $2,435.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $1,704.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "933210",
            "Item/Package": "Item",
            "Description": "DOPPLER LIMITED",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "483",
            "CPT/HCPCS/DRG": "93321",
            " Charge Amount ": " $1,048.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $733.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "933250",
            "Item/Package": "Item",
            "Description": "COLOR FLOW LIMITED",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "483",
            "CPT/HCPCS/DRG": "93325",
            " Charge Amount ": " $1,048.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $733.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90215",
            "Item/Package": "Item",
            "Description": "DOBUTAMINE HCL 250 MG/20 ML ML",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1250",
            " Charge Amount ": " $28.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $19.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90846",
            "Item/Package": "Item",
            "Description": "LUMASON 24.01/ML CHG BY ML",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "Q9950",
            " Charge Amount ": " $167.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $116.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90875",
            "Item/Package": "Item",
            "Description": "LEXISCAN/REGDENOSON 0.4MG/UNIT",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2785",
            " Charge Amount ": " $339.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $237.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90933",
            "Item/Package": "Item",
            "Description": "ABATACEPT 10MG/10MG",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0129",
            " Charge Amount ": " $91.00 ",
            " Min Reimb ": " $49.93 ",
            " Max Reimb ": " $63.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90934",
            "Item/Package": "Item",
            "Description": "BELIMUMAB 120 MG/10MG",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0490",
            " Charge Amount ": " $78.00 ",
            " Min Reimb ": " $41.12 ",
            " Max Reimb ": " $54.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90937",
            "Item/Package": "Item",
            "Description": "CERTOLIZUMAB PEGOL 1MG/1MG",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J0717",
            " Charge Amount ": " $14.00 ",
            " Min Reimb ": " $7.18 ",
            " Max Reimb ": " $9.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90942",
            "Item/Package": "Item",
            "Description": "GOLIMUMAB IV 1MG/1MG",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1602",
            " Charge Amount ": " $41.00 ",
            " Min Reimb ": " $15.92 ",
            " Max Reimb ": " $28.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90943",
            "Item/Package": "Item",
            "Description": "INFLIXIMAB 10MG/10MG",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J1745",
            " Charge Amount ": " $135.00 ",
            " Min Reimb ": " $39.43 ",
            " Max Reimb ": " $94.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90946",
            "Item/Package": "Item",
            "Description": "SOLU MEDROL 125MG/125MG",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J2930",
            " Charge Amount ": " $13.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $9.10 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90947",
            "Item/Package": "Item",
            "Description": "ACTEMRA 80MG/1MG",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3262",
            " Charge Amount ": " $9.00 ",
            " Min Reimb ": " $4.80 ",
            " Max Reimb ": " $6.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90949",
            "Item/Package": "Item",
            "Description": "ACTEMRA 400MG/1MG",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3262",
            " Charge Amount ": " $9.00 ",
            " Min Reimb ": " $4.80 ",
            " Max Reimb ": " $6.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90952",
            "Item/Package": "Item",
            "Description": "ZOLEDRONIC ACID 1MG/1MG",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "J3489",
            " Charge Amount ": " $74.12 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $51.88 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "90978",
            "Item/Package": "Item",
            "Description": "QUAD FLU VAC 3YR/0.5ML",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "636",
            "CPT/HCPCS/DRG": "90688",
            " Charge Amount ": " $34.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $23.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "930050",
            "Item/Package": "Item",
            "Description": "ELECTROCARDIOGRAM TRACING",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "730",
            "CPT/HCPCS/DRG": "93005",
            " Charge Amount ": " $212.00 ",
            " Min Reimb ": " $43.57 ",
            " Max Reimb ": " $148.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "932700",
            "Item/Package": "Item",
            "Description": "EVENT ECG REMOTE 30DAY REV/RPT",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "730",
            "CPT/HCPCS/DRG": "93270",
            " Charge Amount ": " $717.00 ",
            " Min Reimb ": " $32.61 ",
            " Max Reimb ": " $501.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "932710",
            "Item/Package": "Item",
            "Description": "EVENT ECG MONITOR/ ANALYSIS",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "730",
            "CPT/HCPCS/DRG": "93271",
            " Charge Amount ": " $879.00 ",
            " Min Reimb ": " $88.07 ",
            " Max Reimb ": " $615.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "932250",
            "Item/Package": "Item",
            "Description": "HOLTER ECG UP TO 48HRS RECORD",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "731",
            "CPT/HCPCS/DRG": "93225",
            " Charge Amount ": " $971.00 ",
            " Min Reimb ": " $98.29 ",
            " Max Reimb ": " $679.70 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "932260",
            "Item/Package": "Item",
            "Description": "HOLTER ECG 48HRS SCN/ANALY",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "731",
            "CPT/HCPCS/DRG": "93226",
            " Charge Amount ": " $1,186.00 ",
            " Min Reimb ": " $98.29 ",
            " Max Reimb ": " $830.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "I000000006",
            "Item/Package": "Item",
            "Description": "HOLTER EXT 48HR SCN/ANLY",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "731",
            "CPT/HCPCS/DRG": "0297T",
            " Charge Amount ": " $1,127.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $788.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100103",
            "Item/Package": "Item",
            "Description": "Hospital Clinic Visit II",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "G0463",
            " Charge Amount ": " $290.00 ",
            " Min Reimb ": " $155.83 ",
            " Max Reimb ": " $203.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "100104",
            "Item/Package": "Item",
            "Description": "Hospital Clinic Visit I",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "G0463",
            " Charge Amount ": " $174.00 ",
            " Min Reimb ": " $155.83 ",
            " Max Reimb ": " $121.80 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "938800",
            "Item/Package": "Item",
            "Description": "CAROTID DUPLEX SCAN BILAT",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93880",
            " Charge Amount ": " $1,896.00 ",
            " Min Reimb ": " $98.29 ",
            " Max Reimb ": " $1,327.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "938820",
            "Item/Package": "Item",
            "Description": "CAROTID DUPLEX SCAN UNI/LIMIT",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93880",
            " Charge Amount ": " $1,417.00 ",
            " Min Reimb ": " $122.52 ",
            " Max Reimb ": " $991.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939220",
            "Item/Package": "Item",
            "Description": "ANKLE BRACHIAL INDEX",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93922",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939230",
            "Item/Package": "Item",
            "Description": "SEGMENTAL PRESSURE LE MULTI",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93923",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939704",
            "Item/Package": "Item",
            "Description": "US VENOUS DOPPLER LE BI",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93970",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939712",
            "Item/Package": "Item",
            "Description": "US VENOUS DOPPLER LE LT",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93971",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $202.05 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "939713",
            "Item/Package": "Item",
            "Description": "US VENOUS DOPPLER LE RT",
            "Location": "Southwoods Cardiology",
            "Revenue Code": "921",
            "CPT/HCPCS/DRG": "93971",
            " Charge Amount ": " $636.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $445.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "113060",
            "Item/Package": "Item",
            "Description": "SHAVE EPID LESION 0.6CM TO 1CM",
            "Location": "Southwoods Urology",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "11306",
            " Charge Amount ": " $3,969.00 ",
            " Min Reimb ": " $157.64 ",
            " Max Reimb ": " $2,778.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "114000",
            "Item/Package": "Item",
            "Description": "LESION EXC EXTREM < 0.5CM",
            "Location": "Southwoods Urology",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "11400",
            " Charge Amount ": " $3,969.00 ",
            " Min Reimb ": " $546.08 ",
            " Max Reimb ": " $2,778.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "114200",
            "Item/Package": "Item",
            "Description": "LESION EXC GENITALIA <0.5CM",
            "Location": "Southwoods Urology",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "11420",
            " Charge Amount ": " $3,969.00 ",
            " Min Reimb ": " $1,235.32 ",
            " Max Reimb ": " $2,778.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "114210",
            "Item/Package": "Item",
            "Description": "EXC LESION/FULGER 0.6-1.0CM",
            "Location": "Southwoods Urology",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "11421",
            " Charge Amount ": " $3,969.00 ",
            " Min Reimb ": " $546.08 ",
            " Max Reimb ": " $2,778.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "540550",
            "Item/Package": "Item",
            "Description": "FULGERATION OF PENILE LESION",
            "Location": "Southwoods Urology",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "54055",
            " Charge Amount ": " $3,969.00 ",
            " Min Reimb ": " $1,506.05 ",
            " Max Reimb ": " $2,778.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "540600",
            "Item/Package": "Item",
            "Description": "EXCISION CONDYLOMA ACUMIN",
            "Location": "Southwoods Urology",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "54060",
            " Charge Amount ": " $3,969.00 ",
            " Min Reimb ": " $1,506.05 ",
            " Max Reimb ": " $2,778.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "552500",
            "Item/Package": "Item",
            "Description": "VASECTOMY",
            "Location": "Southwoods Urology",
            "Revenue Code": "360",
            "CPT/HCPCS/DRG": "55250",
            " Charge Amount ": " $3,969.00 ",
            " Min Reimb ": " $1,541.67 ",
            " Max Reimb ": " $2,778.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "114230",
            "Item/Package": "Item",
            "Description": "EXC BLES S/N/EX G 2.1-3 OCM",
            "Location": "Southwoods Urology",
            "Revenue Code": "361",
            "CPT/HCPCS/DRG": "11423",
            " Charge Amount ": " $2,542.00 ",
            " Min Reimb ": " $1,235.32 ",
            " Max Reimb ": " $1,779.40 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "517050",
            "Item/Package": "Item",
            "Description": "CYSTOSCOPY TUBE CHANGE",
            "Location": "Southwoods Urology",
            "Revenue Code": "361",
            "CPT/HCPCS/DRG": "51705",
            " Charge Amount ": " $3,888.00 ",
            " Min Reimb ": " $233.66 ",
            " Max Reimb ": " $2,721.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "520000",
            "Item/Package": "Item",
            "Description": "CYSTOSCOPY",
            "Location": "Southwoods Urology",
            "Revenue Code": "361",
            "CPT/HCPCS/DRG": "52000",
            " Charge Amount ": " $3,888.00 ",
            " Min Reimb ": " $504.64 ",
            " Max Reimb ": " $2,721.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "520050",
            "Item/Package": "Item",
            "Description": "CYSTO WITH URETERAL CATH",
            "Location": "Southwoods Urology",
            "Revenue Code": "361",
            "CPT/HCPCS/DRG": "52005",
            " Charge Amount ": " $3,975.00 ",
            " Min Reimb ": " $1,574.21 ",
            " Max Reimb ": " $2,782.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "522040",
            "Item/Package": "Item",
            "Description": "CYSTOSCOPY W/ BIOPSY",
            "Location": "Southwoods Urology",
            "Revenue Code": "361",
            "CPT/HCPCS/DRG": "52204",
            " Charge Amount ": " $4,385.00 ",
            " Min Reimb ": " $1,574.21 ",
            " Max Reimb ": " $3,069.50 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "522240",
            "Item/Package": "Item",
            "Description": "CYSTO W FULLLLG MINOR LESIONS",
            "Location": "Southwoods Urology",
            "Revenue Code": "361",
            "CPT/HCPCS/DRG": "52224",
            " Charge Amount ": " $3,888.00 ",
            " Min Reimb ": " $2,700.97 ",
            " Max Reimb ": " $2,721.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "522810",
            "Item/Package": "Item",
            "Description": "CYSTOSCOPY W/URETHRAL DIL",
            "Location": "Southwoods Urology",
            "Revenue Code": "361",
            "CPT/HCPCS/DRG": "52281",
            " Charge Amount ": " $3,888.00 ",
            " Min Reimb ": " $1,574.21 ",
            " Max Reimb ": " $2,721.60 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "523100",
            "Item/Package": "Item",
            "Description": "CYSTOSCOPY W/ REMOVAL STENT",
            "Location": "Southwoods Urology",
            "Revenue Code": "361",
            "CPT/HCPCS/DRG": "52310",
            " Charge Amount ": " $3,879.00 ",
            " Min Reimb ": " $1,574.21 ",
            " Max Reimb ": " $2,715.30 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "768720",
            "Item/Package": "Item",
            "Description": "US TRANSRECTAL",
            "Location": "Southwoods Urology",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76872",
            " Charge Amount ": " $1,076.00 ",
            " Min Reimb ": " $95.68 ",
            " Max Reimb ": " $753.20 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "769420",
            "Item/Package": "Item",
            "Description": "US GUIDED NEEDLE PLACEMENT",
            "Location": "Southwoods Urology",
            "Revenue Code": "402",
            "CPT/HCPCS/DRG": "76942",
            " Charge Amount ": " $400.00 ",
            " Min Reimb ": " $-   ",
            " Max Reimb ": " $280.00 ",
            " SP ": " INDIVIDUALLY QUOTED "
        },
        {
            "Charge Code": "557000",
            "Item/Package": "Item",
            "Description": "BIOPSY PROSTATE ANY APPROACH",
            "Location": "Southwoods Urology",
            "Revenue Code": "761",
            "CPT/HCPCS/DRG": "55700",
            " Charge Amount ": " $5,357.00 ",
            " Min Reimb ": " $1,574.21 ",
            " Max Reimb ": " $3,749.90 ",
            " SP ": " INDIVIDUALLY QUOTED "
        }
    ]
}