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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": "14-3-3 PROTEIN", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "7253490", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 44.25, "setting": "both", "billing_class": "facility"}]}, {"description": "14-3-3 PROTEIN/2", "code_information": [{"code": 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AGNT NOS AMP PRB/7", "code_information": [{"code": "87798", "type": "CPT"}, {"code": "7257780", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 162.9, "discounted_cash": 122.18, "setting": "both", "billing_class": "facility"}]}, {"description": "INFECT AGNT NOS AMP PRB/8", "code_information": [{"code": "87798", "type": "CPT"}, {"code": "7257810", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 60.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INFECT AGNT NOS DIR OPT/13", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "7257893", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 18.5, "discounted_cash": 13.88, "setting": "both", "billing_class": "facility"}]}, {"description": "INFECT AGNT NOS DIR OPT/15", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "4107908", "type": "CDM"}, {"code": "300", 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"type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321456", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 146.0, "discounted_cash": 109.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM LENTE 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321458", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 164.0, "discounted_cash": 123.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM LENTE 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321458", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 164.0, "discounted_cash": 123.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM NPH 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321461", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 164.0, "discounted_cash": 123.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM NPH 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321461", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 164.0, "discounted_cash": 123.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM REG 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321450", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 164.0, "discounted_cash": 123.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM REG 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321450", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 164.0, "discounted_cash": 123.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM REG DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321451", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 156.0, "discounted_cash": 117.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM REG DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321451", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 156.0, "discounted_cash": 117.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM ULTRALENTE 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321463", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 146.0, "discounted_cash": 109.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM ULTRALENTE 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321463", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 146.0, "discounted_cash": 109.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS LISP 75/25 PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321266", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.94, "discounted_cash": 0.71, "setting": "both", "billing_class": "facility"}]}, {"description": "INS LISP 75/25 PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321266", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 0.94, "discounted_cash": 0.71, "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": 3.0, "discounted_cash": 2.25, "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": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS LNR BEAR HUM VITA E ZIM CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012972", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 34413.0, "discounted_cash": 25809.75, "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": 45031.0, "discounted_cash": 33773.25, "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": 3.0, "discounted_cash": 2.25, "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": 3.0, "discounted_cash": 2.25, "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": 4.0, "discounted_cash": 3.0, "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": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS REG BF/PK 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321425", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 164.0, "discounted_cash": 123.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS REG BF/PK 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321425", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 164.0, "discounted_cash": 123.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS REG BF/PK DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321426", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS REG BF/PK DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321426", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 12.0, "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": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "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": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS TUNN INTRAPER CATH", "code_information": [{"code": "4919418", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16137.0, "discounted_cash": 12102.75, "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": 26690.0, "discounted_cash": 20017.5, "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": 26690.0, "discounted_cash": 20017.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/BEAR CRC/PSC SLP EXACT CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012864", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10966.0, "discounted_cash": 8224.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/PM GEN W/EXIST LD", "code_information": [{"code": "4613212", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6974.0, "discounted_cash": 5230.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/PMGEN W/EXISDUALLDS", "code_information": [{"code": "4612505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16435.0, "discounted_cash": 12326.25, "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": 12691.0, "discounted_cash": 9518.25, "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": 13533.0, "discounted_cash": 10149.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HUM LNR BEAR EXACT CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012841", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10319.0, "discounted_cash": 7739.25, "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": 10497.0, "discounted_cash": 7872.75, "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": 19794.0, "discounted_cash": 14845.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT KNEE TS REV STRYKR CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, 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.175MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306460", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .175MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306460", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306459", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": 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