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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":"Marni Leonard"},"financial_aid_policy":["48% off of standard gross charges."],"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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the standard charge value."},{"payer_name":"Community Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Coordinated Care","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Coordinated Care","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care 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5001-64","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302265","type":"LOCAL"},{"code":"208830","type":"LOCAL"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 302265 = Hospital System Supply Identifier | 208830 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-64-28","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305497","type":"LOCAL"},{"code":"208839","type":"LOCAL"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 305497 = Hospital System Supply Identifier | 208839 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 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68MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280091","type":"LOCAL"},{"code":"522150","type":"LOCAL"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 280091 = Hospital System Supply Identifier | 522150 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 70MM","code_information":[{"code":"Sx00-5001-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280094","type":"LOCAL"},{"code":"522153","type":"LOCAL"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 280094 = Hospital System Supply Identifier | 522153 = Lawson ID"}]},{"description":"IMP HIP SHELL MULTPLR 72","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303147","type":"LOCAL"},{"code":"408144","type":"LOCAL"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 303147 = Hospital System Supply Identifier | 408144 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 72MM","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280095","type":"LOCAL"},{"code":"522154","type":"LOCAL"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 280095 = Hospital System Supply Identifier | 522154 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 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38-43MM","code_information":[{"code":"Sx00-5003-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"26951","type":"LOCAL"},{"code":"310982","type":"LOCAL"}],"standard_charges":[{"gross_charge":948.78,"discounted_cash":493.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 26951 = Hospital System Supply Identifier | 310982 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 28 44-49MM","code_information":[{"code":"Sx00-5003-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"26952","type":"LOCAL"},{"code":"310983","type":"LOCAL"}],"standard_charges":[{"gross_charge":948.78,"discounted_cash":493.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 26952 = Hospital System Supply Identifier | 310983 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 28 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5051-05","code_information":[{"code":"Sx00-5051-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"61824","type":"LOCAL"},{"code":"114300","type":"LOCAL"}],"standard_charges":[{"gross_charge":867.3,"discounted_cash":451.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 61824 = Hospital System Supply Identifier | 114300 = Lawson ID"}]},{"description":"BLADE MICRO MILL 19 204","code_information":[{"code":"Sx00-5052-204","type":"CDM"},{"code":"272","type":"RC"},{"code":"144389","type":"LOCAL"},{"code":"100437","type":"LOCAL"}],"standard_charges":[{"gross_charge":726.49,"discounted_cash":377.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 144389 = Hospital System Supply Identifier | 100437 = Lawson ID"}]},{"description":"BLADE SAW 17 X 4 MM RECIPROCATING ROUND 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HLDNG","code_information":[{"code":"Sx00-5061-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"12394","type":"LOCAL"},{"code":"237595","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.24,"discounted_cash":62.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 12394 = Hospital System Supply Identifier | 237595 = Lawson ID"}]},{"description":"SYSTEM BONE CEMENT NSTRL REMOV","code_information":[{"code":"Sx00-5061-084","type":"CDM"},{"code":"272","type":"RC"},{"code":"889398","type":"LOCAL"},{"code":"816445","type":"LOCAL"}],"standard_charges":[{"gross_charge":474.39,"discounted_cash":246.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 889398 = Hospital System Supply Identifier | 816445 = Lawson ID"}]},{"description":"PRESSURIZER FEM HARRIS 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0051040000","code_information":[{"code":"Sx00-510-400-","type":"CDM"},{"code":"272","type":"RC"},{"code":"1026197","type":"LOCAL"},{"code":"1008181","type":"LOCAL"}],"standard_charges":[{"gross_charge":11136.12,"discounted_cash":5790.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 1026197 = Hospital System Supply Identifier | 1008181 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ2","code_information":[{"code":"Sx00-5110-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300733","type":"LOCAL"},{"code":"534942","type":"LOCAL"}],"standard_charges":[{"gross_charge":27459.52,"discounted_cash":14278.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 300733 = Hospital System Supply Identifier | 534942 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT 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11","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300744","type":"LOCAL"},{"code":"534953","type":"LOCAL"}],"standard_charges":[{"gross_charge":15691.68,"discounted_cash":8159.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 300744 = Hospital System Supply Identifier | 534953 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A B 13","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300745","type":"LOCAL"},{"code":"534954","type":"LOCAL"}],"standard_charges":[{"gross_charge":15691.68,"discounted_cash":8159.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 300745 = Hospital System Supply Identifier | 534954 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A B 15","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300746","type":"LOCAL"},{"code":"534955","type":"LOCAL"}],"standard_charges":[{"gross_charge":15691.68,"discounted_cash":8159.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 300746 = Hospital System Supply Identifier | 534955 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A B 17","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300747","type":"LOCAL"},{"code":"534956","type":"LOCAL"}],"standard_charges":[{"gross_charge":15691.68,"discounted_cash":8159.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 300747 = Hospital System Supply Identifier | 534956 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A B 20","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300748","type":"LOCAL"},{"code":"534957","type":"LOCAL"}],"standard_charges":[{"gross_charge":15691.68,"discounted_cash":8159.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 300748 = Hospital System Supply Identifier | 534957 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A B 23","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300749","type":"LOCAL"},{"code":"534958","type":"LOCAL"}],"standard_charges":[{"gross_charge":15691.68,"discounted_cash":8159.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 300749 = Hospital System Supply Identifier | 534958 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII C D 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20MM","code_information":[{"code":"Sx00-5960-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280402","type":"LOCAL"},{"code":"522461","type":"LOCAL"}],"standard_charges":[{"gross_charge":4470.0,"discounted_cash":2324.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 280402 = Hospital System Supply Identifier | 522461 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 3-4 20MM","code_information":[{"code":"Sx00-5960-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280407","type":"LOCAL"},{"code":"522466","type":"LOCAL"}],"standard_charges":[{"gross_charge":4470.0,"discounted_cash":2324.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSP LOCATION | 280407 = Hospital System Supply Identifier | 522466 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 3-4 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