; (BB) the patient mix, broken down by expected payment source (including at least the Medicare program under title XVIII of the Social Security Act, a State plan under the Medicaid program under title XIX of such Act, private insurance, and uninsured), for each child site of the hospital listed in the covered entity information system established under subsection (d)(2)(B)(iv), the costs incurred at each site for charity care (as described in line 23 of Worksheet S–10—Hospital Uncompensated and Indigent Care Data to the Medicare cost report or as reported in any successor form); (CC) the percent of total revenues at each site derived from infusion or injection of physician-administered drugs