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For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Geoffrey Vines"}, "standard_charge_information": [{"description": "11-DEOXYXORTISL", "code_information": [{"code": "82634", "type": "CPT"}, {"code": "7252517", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 519.0, "discounted_cash": 389.25, "setting": "both", "billing_class": "facility"}]}, {"description": "3D ECHO IMG CGEN CAR ANOMAL", 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48.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS ASPART PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321256", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS BEAR JRNY II XR XLPE SN CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012889", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10326.0, "discounted_cash": 7744.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS BEARNG KNEE PLY MEDACTA CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6846.0, "discounted_cash": 5134.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST BIL", "code_information": [{"code": "4616252", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19669.0, "discounted_cash": 14751.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST BIL", "code_information": [{"code": "4916252", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 18212.0, "discounted_cash": 13659.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST UNI", "code_information": [{"code": "4616251", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19669.0, "discounted_cash": 14751.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST UNI", "code_information": [{"code": "4916251", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19669.0, "discounted_cash": 14751.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND UNI", "code_information": [{"code": "4916253", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 20433.0, "discounted_cash": 15324.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS DETEMR PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321258", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS DETEMR PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321258", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS ENDOVA VENACAVA FILT", "code_information": [{"code": "4617191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 24502.0, "discounted_cash": 18376.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS ENDOVA VENACAVA FILT", "code_information": [{"code": "4917191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 26461.0, "discounted_cash": 19845.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS GLARG PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321260", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS GLARG PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321260", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS GLARGINE-YFGN PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321518", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS GLARGINE-YFGN PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321518", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS H REG 500U 20ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321384", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 189.0, "discounted_cash": 141.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS H REG 500U 20ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321384", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 189.0, "discounted_cash": 141.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS LINR BEAR HUM ARTHROSRF CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18227.0, "discounted_cash": 13670.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS LISPRO PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321264", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS LISPRO PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321264", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS LV LD W/PM OR AICD", "code_information": [{"code": "4613225", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 42197.0, "discounted_cash": 31647.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS N/R 70/30 PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321270", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS N/R 70/30 PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321270", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS NPH HUM PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321262", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS NPH HUM PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321262", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS POLY INFNTY EVRLST CRSSLK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012683", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23202.0, "discounted_cash": 17401.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS REG HUM PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321265", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS REG HUM PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321265", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS TIB PLY INFNTY BIOFM 3DSZ3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012681", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66229.0, "discounted_cash": 49671.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS TUNN INTRAPER CATH", "code_information": [{"code": "4919418", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 29329.0, "discounted_cash": 21996.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS VAD LEFT HRT PERC ART", "code_information": [{"code": "4613986", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23927.0, "discounted_cash": 17945.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS VAD LEFT PERC ART/VEIN", "code_information": [{"code": "4613987", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23927.0, "discounted_cash": 17945.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/PMGEN W/EXISDUALLDS", "code_information": [{"code": "4612505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 79074.0, "discounted_cash": 59305.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/RPL PM W/TRNSV LD AT", "code_information": [{"code": "4613206", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21314.0, "discounted_cash": 15985.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/RPL PM W/TRNSV LD VE", "code_information": [{"code": "4613207", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 48289.0, "discounted_cash": 36216.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/RPL PMW/TRNSV LD A-V", "code_information": [{"code": "4613208", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 48289.0, "discounted_cash": 36216.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ARTICULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15489.0, "discounted_cash": 11616.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HUM LNR BEAR DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13298.0, "discounted_cash": 9973.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HUM LNR BEAR ZIMMER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012937", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8156.0, "discounted_cash": 6117.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HUMERAL STD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137719", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 49083.0, "discounted_cash": 36812.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT KNEE POLY UNI DJO CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3505.0, "discounted_cash": 2628.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT KNEE REVIS EXACT CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013139", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16353.0, "discounted_cash": 12264.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT KNEE REVISION SN CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012883", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15489.0, "discounted_cash": 11616.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT KNEE TS REV STRYKR CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15489.0, "discounted_cash": 11616.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PHALANGEAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137727", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9124.0, "discounted_cash": 6843.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT POLY ANKLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22780.0, "discounted_cash": 17085.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SCRW PLT LCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 498.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SWANGANZ CATHETER", "code_information": [{"code": "93503", "type": "CPT"}, {"code": "4613535", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"gross_charge": 26900.0, "discounted_cash": 20175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SWANGANZ CATHETER", "code_information": [{"code": "93503", "type": "CPT"}, {"code": "4613535", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"gross_charge": 26900.0, "discounted_cash": 20175.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 21906.0, "discounted_cash": 16429.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL ANY DJO CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22396.0, "discounted_cash": 16797.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT/BEARING POLY EXACT CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012865", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14242.0, "discounted_cash": 10681.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSIT MLTIPLX STAIN CMPT", "code_information": [{"code": "88374", "type": "CPT"}, {"code": "7068374", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 2024.0, "discounted_cash": 1518.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSIT MLTIPLX STAIN CMPT", "code_information": [{"code": "88374", "type": "CPT"}, {"code": "7258516", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 2206.0, "discounted_cash": 1654.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSIT MLTIPLX STAIN CMPT", "code_information": [{"code": "88374", "type": "CPT"}, {"code": "7270097", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 2024.0, "discounted_cash": 1518.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSITU 1ST PRB MANUAL", "code_information": [{"code": "88368", "type": "CPT"}, {"code": "7258837", "type": "CDM"}, {"code": "310", "type": "RC"}], 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