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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": "17-HYDROXY PREGNENOLONE", "code_information": [{"code": "84143", "type": "CPT"}, {"code": "7258414", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 30.75, "setting": "both", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "21 HYDROXYLASE AB/2", 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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": 16.0, "discounted_cash": 12.0, "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": 16.0, "discounted_cash": 12.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS GLARGINE 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321407", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 717.0, "discounted_cash": 537.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS GLARGINE 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321407", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 717.0, "discounted_cash": 537.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS GLARGINE DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321408", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS GLARGINE DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321408", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 126.0, "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": 3.0, "discounted_cash": 2.25, "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": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM 70/30 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321456", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 403.0, "discounted_cash": 302.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM 70/30 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321456", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 403.0, "discounted_cash": 302.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM 70/30 DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321457", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 66.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM 70/30 DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321457", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 66.75, "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": 652.0, "discounted_cash": 489.0, "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": 652.0, "discounted_cash": 489.0, "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": 398.0, "discounted_cash": 298.5, "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": 398.0, "discounted_cash": 298.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM NPH DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321462", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 66.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM NPH DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321462", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 66.75, "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": 679.0, "discounted_cash": 509.25, "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": 679.0, "discounted_cash": 509.25, "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": 89.0, "discounted_cash": 66.75, "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": 89.0, "discounted_cash": 66.75, "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": 12.0, "discounted_cash": 9.0, "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": 12.0, "discounted_cash": 9.0, "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": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "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": 17.0, "discounted_cash": 12.75, "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": 21667.0, "discounted_cash": 16250.25, "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": 5.0, "discounted_cash": 3.75, "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": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "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": 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": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "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": 3.0, "discounted_cash": 2.25, "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": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS TUNN INTRAPER CATH", "code_information": [{"code": "4619418", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 41722.0, "discounted_cash": 31291.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS TUNN INTRAPER CATH", "code_information": [{"code": "4919418", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 45060.0, "discounted_cash": 33795.0, "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": 18171.0, "discounted_cash": 13628.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/PMGEN W/EXISDUALLDS", "code_information": [{"code": "4612505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16595.0, "discounted_cash": 12446.25, "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": 14085.0, "discounted_cash": 10563.75, "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": 40296.0, "discounted_cash": 30222.0, "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": 9301.0, "discounted_cash": 6975.75, "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": 20516.0, "discounted_cash": 15387.0, "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": 57706.0, "discounted_cash": 43279.5, "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": 8668.0, "discounted_cash": 6501.0, "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": 8668.0, "discounted_cash": 6501.0, "setting": "both", "billing_class": "facility"}]}, 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