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"negotiated_rate": 62.62, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 62.62, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 83.34, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 83.34, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Clozapine", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80159", "description": "Clozapine", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 18.14, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 22.23, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 22.23, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 32.7, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 32.7, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 34.66, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 34.66, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "TEMPOROMANDBLE JT ARTHROGRAPHY RS&I", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "70332", "description": "TEMPOROMANDBLE JT ARTHROGRAPHY RS&I", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.84, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 36.82, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 36.82, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 43.0, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 49.0, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 49.0, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 64.85, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 77.4, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 77.4, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 82.18, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 82.18, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 103.01, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 103.01, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 114.22, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 114.22, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 152.0, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 152.0, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Glucagon tolerance panel; for insulinoma This panel must include the following: Glucose (82947 x 3) Insulin (83525 x 3)", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80422", "description": "Glucagon tolerance panel; for insulinoma This panel must include the following: Glucose (82947 x 3) Insulin (83525 x 3)", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 41.46, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 50.81, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 50.81, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 74.78, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 74.78, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 79.24, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 79.24, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "78816", "description": "Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 96.36, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 159.93, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 159.93, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 212.84, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 212.84, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 2520.29, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 2662.5, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Pot", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80053", "description": "Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Pot", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 9.5, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 9.5, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 11.64, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 11.64, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 11.64, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 11.64, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 17.14, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 17.14, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 17.14, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 17.14, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 18.16, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 18.16, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 18.16, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 18.16, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "pulpal regeneration - completion of treatment", "billing_code_type": "HCPCS", "billing_code_type_version": "2020", "billing_code": "D3357", "description": "pulpal regeneration - completion of treatment", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 930.87, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] } ] }, { "negotiation_arrangement": "ffs", "name": "INJ INFLIXIMAB-AXXQ BIOSIMILAR AVSOLA 10 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2020", "billing_code": "Q5121", "description": "INJ INFLIXIMAB-AXXQ BIOSIMILAR AVSOLA 10 MG", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 49.96, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 49.96, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 73.52, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 73.52, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Theophylline", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80198", "description": "Theophylline", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 12.73, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 15.6, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], 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"negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 169.5, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] } ] }, { "negotiation_arrangement": "ffs", "name": "RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "70160", "description": "RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 7.07, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 11.78, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 11.78, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 15.67, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 15.67, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 22.69, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 29.76, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 38.28, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 38.28, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { 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{ "negotiated_type": "negotiated", "negotiated_rate": 50.94, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 50.94, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 66.61, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 66.61, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] } ] }, { "negotiation_arrangement": "ffs", "name": "MRI TEMPOROMANDIBULAR JOINT", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "70336", "description": "MRI TEMPOROMANDIBULAR JOINT", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 58.74, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 98.37, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 98.37, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], 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"both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 55.69, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 55.69, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 81.97, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 81.97, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 86.86, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 86.86, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "DRUG ASSAY CARBAMAZEPINE -10,11-EPOXIDE", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80161", "description": "DRUG ASSAY CARBAMAZEPINE -10,11-EPOXIDE", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 16.78, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 20.56, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 20.56, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 30.25, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 30.25, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 32.06, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 32.06, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Obstetric panel This panel must include the following: Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80055", "description": "Obstetric panel This panel must include the following: Blood count, complete 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"professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 23.34, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 23.34, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 26.44, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", 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{ "negotiated_type": "negotiated", "negotiated_rate": 163.67, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 163.67, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 240.87, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 240.87, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 255.27, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 255.27, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Mycophenolate (mycophenolic acid)", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80180", "description": "Mycophenolate (mycophenolic acid)", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 16.25, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 19.9, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 19.9, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 29.29, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 29.29, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 31.05, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 31.05, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "96133", "description": "NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 81.24, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 94.42, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 104.17, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 118.98, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 131.29, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] } ] }, { "negotiation_arrangement": "ffs", "name": "CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "78483", "description": "CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 57.21, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 96.56, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 96.56, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 116.22, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 128.5, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 128.5, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 173.43, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 209.43, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 209.43, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 278.73, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 278.73, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 305.97, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 305.97, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 407.2, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 407.2, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] } ] }, { "negotiation_arrangement": "ffs", "name": "RP LOCLZJ TUM SPECT 2 AREA/SEP ACQUISJ IMG", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "78831", "description": "RP LOCLZJ TUM SPECT 2 AREA/SEP ACQUISJ IMG", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 70.7, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 117.17, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 117.17, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 155.95, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 155.95, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 423.68, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 494.38, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 753.33, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 753.33, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 809.71, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 809.71, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 870.5, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 870.5, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 1002.59, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 1002.59, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 1158.54, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 1158.54, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Digoxin; total", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80162", "description": "Digoxin; total", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 11.95, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.65, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.65, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.55, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.55, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 22.84, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 22.84, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "apicoectomy - premolar (first root)", "billing_code_type": "HCPCS", "billing_code_type_version": "2020", "billing_code": "D3421", "description": "apicoectomy - premolar (first root)", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 1091.26, "expiration_date": "9999-12-31", "service_code": [ "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 8 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 1296.54, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 2219.46, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 14 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 2329.94, "expiration_date": "9999-12-31", "service_code": [ "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478)", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80061", "description": "Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478)", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 12.05, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 12.05, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.76, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.76, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.76, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.76, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.74, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.74, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.74, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.74, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 23.03, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 23.03, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { 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"negotiated_type": "negotiated", "negotiated_rate": 1472.6, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 2219.46, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 14 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 2329.94, "expiration_date": "9999-12-31", "service_code": [ "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Growth hormone stimulation panel (eg, arginine infusion, l-dopa administration) This panel must include the following: Human growth hormone (HGH) (83003 x 4)", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80428", "description": "Growth hormone stimulation panel (eg, arginine infusion, l-dopa administration) This panel must include the following: Human growth hormone (HGH) (83003 x 4)", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 60.03, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 73.55, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 73.55, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 108.25, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 108.25, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 114.72, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 114.72, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "DRUG ASSAY FLECAINIDE", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80181", "description": "DRUG ASSAY FLECAINIDE", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 16.78, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 20.56, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 20.56, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 30.25, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 30.25, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 32.06, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 32.06, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Digoxin; free", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80163", "description": "Digoxin; free", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 11.95, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.65, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.65, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.55, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.55, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 22.84, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 22.84, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "96136", "description": "PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 28.52, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 31.48, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 34.47, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 50.52, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 55.74, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] } ] }, { "negotiation_arrangement": "ffs", "name": "RP LOCLZJ TUM SPECT CT 2AREA/SEP ACQUISJ IMG", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "78832", "description": "RP LOCLZJ TUM SPECT CT 2AREA/SEP ACQUISJ IMG", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 81.31, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 136.16, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 136.16, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 181.21, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 181.21, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 545.04, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 626.34, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 995.41, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 995.41, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 1041.63, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 1041.63, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 1131.56, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 1131.56, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 1324.77, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 1324.77, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 1505.97, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 1505.97, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] } ] }, { "negotiation_arrangement": "ffs", "name": "RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "78800", "description": "RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 25.92, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 43.01, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 43.01, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 57.24, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 57.24, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 152.72, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 178.64, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 270.05, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 270.05, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 313.06, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 313.06, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 359.4, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 359.4, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 416.64, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 416.64, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100) Potassium (84132) Sodium (", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80069", "description": "Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100) Potassium (84132) Sodium (", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 7.81, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 7.81, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 9.57, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 9.57, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 9.57, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 9.57, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.09, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.09, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.09, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.09, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.93, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.93, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.93, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.93, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "QW" ] } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "81000", "description": "Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 3.62, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 4.44, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 4.44, "expiration_date": "9999-12-31", 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}, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 29.92, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 39.81, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 39.81, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 51.99, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 69.93, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 94.59, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 94.59, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 99.36, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 99.36, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 124.51, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 124.51, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 125.89, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 125.89, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 165.72, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 165.72, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Human Platelet Antigen 5 genotyping (HPA-5), ITGA2 (integrin, alpha 2 [CD49B, alpha 2 subunit of VLA-2 receptor] [GPIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant (eg, HPA-5a/b (K505E))", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "81109", "description": "Human Platelet Antigen 5 genotyping (HPA-5), ITGA2 (integrin, alpha 2 [CD49B, alpha 2 subunit of VLA-2 receptor] [GPIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant (eg, HPA-5a/b (K505E))", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 110.0, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 134.78, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 134.78, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 198.36, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 198.36, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 210.22, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 210.22, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Growth hormone suppression panel (glucose administration) This panel must include the following: Glucose (82947 x 3) Human growth hormone (HGH) (83003 x 4)", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80430", "description": "Growth hormone suppression panel (glucose administration) This panel must include the following: Glucose (82947 x 3) Human growth hormone (HGH) (83003 x 4)", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 116.4, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 142.63, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 142.63, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 209.91, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 209.91, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 222.45, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 222.45, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Oxcarbazepine", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80183", "description": "Oxcarbazepine", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 11.93, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.62, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.62, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.5, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.5, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 22.79, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 22.79, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Injection, octafluoropropane microspheres, per ml", "billing_code_type": "HCPCS", "billing_code_type_version": "2020", "billing_code": "Q9956", "description": "Injection, octafluoropropane microspheres, per ml", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 33.94, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 33.94, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 49.94, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 49.94, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] } ] }, { "negotiation_arrangement": "ffs", "name": "PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "96137", "description": "PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 22.17, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 24.46, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 30.17, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 45.27, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 49.95, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg) (87340) Hepatitis C antibody (86803)", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80074", "description": "Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg) (87340) Hepatitis C antibody (86803)", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 42.87, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 52.53, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 52.53, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 77.31, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 77.31, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 81.92, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 81.92, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "81001", "description": "Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 2.85, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 3.5, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 3.5, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 5.15, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 5.15, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 5.45, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 5.45, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Valproic acid (dipropylacetic acid); total", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80164", "description": "Valproic acid (dipropylacetic acid); total", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 12.19, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.93, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.93, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.97, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.97, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 23.29, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 23.29, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "70370", "description": "RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 12.8, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 20.86, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 20.86, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 27.75, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 27.75, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 67.68, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 80.48, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 113.94, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 113.94, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 129.34, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 129.34, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 134.8, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 134.8, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 151.65, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 151.65, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 179.41, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 179.41, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] } ] }, { "negotiation_arrangement": "ffs", "name": "MYOCRD IMG PET PRFUJ MULTIPLE STUDY REST&STRESS", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "78492", "description": "MYOCRD IMG PET PRFUJ MULTIPLE STUDY REST&STRESS", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 69.98, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 117.47, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 117.47, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 156.35, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 156.35, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Radiologic examination, sinuses, paranasal, less than 3 views", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "70210", "description": "Radiologic examination, sinuses, paranasal, less than 3 views", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 7.07, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 11.78, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 11.78, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 15.67, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 15.67, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 18.58, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 25.66, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 30.98, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 30.98, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 35.5, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 35.5, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 41.22, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 41.22, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 42.75, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 42.75, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 56.89, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 56.89, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] } ] }, { "negotiation_arrangement": "ffs", "name": "ACTH stimulation panel; for 21 hydroxylase deficiency This panel must include the following: Cortisol (82533 x 2) 17 hydroxyprogesterone (83498 x 2)", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80402", "description": "ACTH stimulation panel; for 21 hydroxylase deficiency This panel must include the following: Cortisol (82533 x 2) 17 hydroxyprogesterone (83498 x 2)", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 78.26, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 95.9, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 95.9, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 141.14, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 141.14, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 149.57, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 149.57, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Vancomycin", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80202", "description": "Vancomycin", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 12.19, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.93, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.93, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.97, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.97, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 23.29, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 23.29, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "bone graft in conjunction with periradicular surgery - per tooth, single site", "billing_code_type": "HCPCS", "billing_code_type_version": "2020", "billing_code": "D3428", "description": "bone graft in conjunction with periradicular surgery - per tooth, single site", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 777.65, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Injection, perflutren lipid microspheres, per ml", "billing_code_type": "HCPCS", "billing_code_type_version": "2020", "billing_code": "Q9957", "description": "Injection, perflutren lipid microspheres, per ml", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 50.9, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 50.9, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 74.9, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 74.9, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] } ] }, { "negotiation_arrangement": "ffs", "name": "INJECTION DOXORUBICIN HCL LIPOSOMAL NOS 10 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2020", "billing_code": "Q2050", "description": "INJECTION DOXORUBICIN HCL LIPOSOMAL NOS 10 MG", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 221.14, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 221.14, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 325.45, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 325.45, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Human Platelet Antigen 6 genotyping (HPA-6w), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa, antigen CD61] [GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-6a/b (R489Q)", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "81110", "description": "Human Platelet Antigen 6 genotyping (HPA-6w), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa, antigen CD61] [GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-6a/b (R489Q)", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 110.0, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 134.78, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 134.78, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 198.36, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 198.36, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 210.22, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 210.22, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Neonates, Died or Transferred to Another Acute Care Facility", "billing_code_type": "MS-DRG", "billing_code_type_version": "2020", "billing_code": "789", "description": "Neonates, Died or Transferred to Another Acute Care Facility", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "percentage", "negotiated_rate": 70.0, "expiration_date": "9999-12-31", "service_code": [ "21", "51", "61" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "percentage", "negotiated_rate": 70.0, "expiration_date": "9999-12-31", "service_code": [ "21", "51", "61" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Insulin-induced C-peptide suppression panel This panel must include the following: Insulin (83525) C-peptide (84681 x 5) Glucose (82947 x 5)", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80432", "description": "Insulin-induced C-peptide suppression panel This panel must include the following: Insulin (83525) C-peptide (84681 x 5) Glucose (82947 x 5)", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 149.05, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 182.64, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 182.64, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 268.79, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 268.79, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 284.85, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 284.85, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Phenobarbital", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80184", "description": "Phenobarbital", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 13.77, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 16.87, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 16.87, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 24.84, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 24.84, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 26.32, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 26.32, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "96138", "description": "PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 26.8, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 37.41, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 37.41, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 41.28, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 41.28, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] } ] }, { "negotiation_arrangement": "ffs", "name": "CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "70371", "description": "CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 35.21, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 54.05, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 56.23, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 56.23, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 74.84, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 74.84, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "26" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 83.41, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 83.41, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 89.25, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 103.3, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 103.3, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 111.01, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 111.01, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both", "billing_code_modifier": [ "TC" ] } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 139.64, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 139.64, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 185.84, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 185.84, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "81002", "description": "Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 3.13, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 3.84, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 3.84, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 5.65, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 5.65, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 5.99, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 5.99, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80076", "description": "Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 7.35, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 9.01, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 9.01, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 13.27, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 13.27, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.05, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.05, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Valproic acid (dipropylacetic acid); free", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80165", "description": "Valproic acid (dipropylacetic acid); free", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 12.19, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.93, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.93, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.97, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 21.97, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 23.29, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 23.29, "expiration_date": "9999-12-31", "service_code": [ "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml", "billing_code_type": "HCPCS", "billing_code_type_version": "2020", "billing_code": "Q9958", "description": "High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 0.07, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 0.07, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 5, 6 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 0.11, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 0.11, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 4, 3 ] } ] }, { "negotiation_arrangement": "ffs", "name": "Zonisamide", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "80203", "description": "Zonisamide", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 11.93, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 14.62, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": [ { 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"billing_code_type_version": "2020", "billing_code": "D3430", "description": "retrograde filling - per root", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 371.99, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 1091.26, "expiration_date": "9999-12-31", "service_code": [ "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 8 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 2219.46, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 14 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 2329.94, "expiration_date": "9999-12-31", "service_code": [ "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 12 ] } ] }, { "negotiation_arrangement": "ffs", "name": "CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; evaluation to detect abnormal (eg, expanded) alleles", "billing_code_type": "CPT", "billing_code_type_version": "2020", "billing_code": "81188", "description": "CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; evaluation to detect abnormal (eg, expanded) alleles", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 123.3, "expiration_date": "9999-12-31", "service_code": [], "billing_class": "professional", "setting": "both" } ], "provider_references": [ 0 ] }, { "negotiated_prices": [ { "negotiated_type": "negotiated", "negotiated_rate": 151.08, "expiration_date": "9999-12-31", "service_code": [ "21", "22", "23", "24" ], "billing_class": "institutional", "setting": "both" } ], "provider_references": [ 4, 3 ] }, { "negotiated_prices": 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