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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": 377.0, "discounted_cash": 282.75, "setting": "both", "billing_class": "facility"}]}, {"description": "17-HYDROXY PREGNENOLONE", "code_information": 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2253.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INFECT AGNT NOS AMP PRB/24", "code_information": [{"code": "87798", "type": "CPT"}, {"code": "7258785", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 433.0, "discounted_cash": 324.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INFECT AGNT NOS AMP PRB/26", "code_information": [{"code": "87798", "type": "CPT"}, {"code": "7257797", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 2933.0, "discounted_cash": 2199.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INFECT AGNT NOS AMP PRB/29", "code_information": [{"code": "87798", "type": "CPT"}, {"code": "7257915", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 6102.0, "discounted_cash": 4576.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INFECT AGNT NOS AMP PRB/3", 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5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321269", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS ASPR 70/30 PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321269", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 10.5, "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": 7965.0, "discounted_cash": 5973.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST BIL", 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"5321436", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 109.0, "discounted_cash": 81.75, "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": 14.0, "discounted_cash": 10.5, "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": 14.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS ENDOVA VENACAVA FILT", "code_information": [{"code": "4617191", "type": "CDM"}, {"code": "360", "type": "RC"}], 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"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": 1603.0, "discounted_cash": 1202.25, "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": 1603.0, "discounted_cash": 1202.25, "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": 98.0, "discounted_cash": 73.5, "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": 98.0, "discounted_cash": 73.5, "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": "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 50/50 DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321386", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 107.0, "discounted_cash": 80.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS HUM 50/50 DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321386", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 107.0, "discounted_cash": 80.25, "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": 876.0, "discounted_cash": 657.0, "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": 876.0, "discounted_cash": 657.0, "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 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": 965.0, "discounted_cash": 723.75, "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": 965.0, "discounted_cash": 723.75, "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": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 67.5, "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": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 67.5, "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": 788.0, "discounted_cash": 591.0, "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": 788.0, "discounted_cash": 591.0, "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": 107.0, "discounted_cash": 80.25, "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": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 107.0, "discounted_cash": 80.25, "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": 16426.0, "discounted_cash": 12319.5, "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": 2.0, "discounted_cash": 1.5, "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": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "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 LV LD W/PM OR AICD", "code_information": [{"code": "4613225", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6925.0, "discounted_cash": 5193.75, "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": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": 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"billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306467", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 66.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306467", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 66.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315477", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 36.0, "setting": 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