{"reporting_entity_name": "GQO_PPO","reporting_entity_type": "GQO_Risk Assuming Non Licensed Insurer","last_updated_on": "2026-10-07","version": "2.0","provider_references": [                                                                                                                                                         
{"provider_group_id":439136482,"network_name":[],"provider_groups":[{"npi":[1013914456,1033101522,1194721803,1578502167,1588661938,1700826609,1811993520,1841297736,1891792255,1992701692],"tin":{"type":"ein","value":"470956610","business_name":"Greater Hazleton Radiology Associates Llc"}}]}
], "in_network" : [
{"negotiation_arrangement":"ffs","name":"X-rays bone survey limited","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77074","description":"X-rays bone survey limited","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":48.46,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-rays bone survey limited","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77074","description":"X-rays bone survey limited","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":18.23,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-rays bone survey limited","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77074","description":"X-rays bone survey limited","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":30.22,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct perfusion w/contrast cbf","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"0042T","description":"Ct perfusion w/contrast cbf","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":250.38,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray exam of wrist","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73110","description":"X-ray exam of wrist","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":22.3,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray exam of wrist","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73110","description":"X-ray exam of wrist","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":15.2,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray exam of wrist","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73110","description":"X-ray exam of wrist","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":7.1,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Radiopharmaceutical Localization Of Tumor_ Inflammatory Process Or Distribution Of Radiopharmaceutical Agent(S) (Includes Vascular Flow And Blood Pool Imaging_ When Performed)","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78831","description":"Radiopharmaceutical Localization Of Tumor_ Inflammatory Process Or Distribution Of Radiopharmaceutical Agent(S) (Includes Vascular Flow And Blood Pool Imaging_ When Performed)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":87.95,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Radiopharmaceutical Localization Of Tumor_ Inflammatory Process Or Distribution Of Radiopharmaceutical Agent(S) (Includes Vascular Flow And Blood Pool Imaging_ When Performed)","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78831","description":"Radiopharmaceutical Localization Of Tumor_ Inflammatory Process Or Distribution Of Radiopharmaceutical Agent(S) (Includes Vascular Flow And Blood Pool Imaging_ When Performed)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":604.03,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Radiopharmaceutical Localization Of Tumor_ Inflammatory Process Or Distribution Of Radiopharmaceutical Agent(S) (Includes Vascular Flow And Blood Pool Imaging_ When Performed)","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78831","description":"Radiopharmaceutical Localization Of Tumor_ Inflammatory Process Or Distribution Of Radiopharmaceutical Agent(S) (Includes Vascular Flow And Blood Pool Imaging_ When Performed)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":604.03,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Radiopharmaceutical Localization Of Tumor_ Inflammatory Process Or Distribution Of Radiopharmaceutical Agent(S) (Includes Vascular Flow And Blood Pool Imaging_ When Performed)","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78831","description":"Radiopharmaceutical Localization Of Tumor_ Inflammatory Process Or Distribution Of Radiopharmaceutical Agent(S) (Includes Vascular Flow And Blood Pool Imaging_ When Performed)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":691.97,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Radiopharmaceutical Localization Of Tumor_ Inflammatory Process Or Distribution Of Radiopharmaceutical Agent(S) (Includes Vascular Flow And Blood Pool Imaging_ When Performed)","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78831","description":"Radiopharmaceutical Localization Of Tumor_ Inflammatory Process Or Distribution Of Radiopharmaceutical Agent(S) (Includes Vascular Flow And Blood Pool Imaging_ When Performed)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":691.97,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Radiopharmaceutical Localization Of Tumor_ Inflammatory Process Or Distribution Of Radiopharmaceutical Agent(S) (Includes Vascular Flow And Blood Pool Imaging_ When Performed)","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78831","description":"Radiopharmaceutical Localization Of Tumor_ Inflammatory Process Or Distribution Of Radiopharmaceutical Agent(S) (Includes Vascular Flow And Blood Pool Imaging_ When Performed)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":87.95,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Special radiation dosimetry","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77331","description":"Special radiation dosimetry","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":49.5,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Special radiation dosimetry","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77331","description":"Special radiation dosimetry","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":35.1,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Special radiation dosimetry","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77331","description":"Special radiation dosimetry","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":14.4,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Liver & spleen image/flow","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78216","description":"Liver & spleen image/flow","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":124.1,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Liver & spleen image/flow","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78216","description":"Liver & spleen image/flow","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":23.0,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Liver & spleen image/flow","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78216","description":"Liver & spleen image/flow","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":101.0,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI brain stem w/o dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"70551","description":"MRI brain stem w/o dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":287.88,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Percutaneous transcatheter closure of paravalvular leak; initial occlusion device_ mitral valve","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"93590","description":"Percutaneous transcatheter closure of paravalvular leak; initial occlusion device_ mitral valve","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":982.42,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI brain stem w/o dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"70551","description":"MRI brain stem w/o dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":363.12,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI brain stem w/o dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"70551","description":"MRI brain stem w/o dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":75.24,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct lwr extremity w/o&w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73702","description":"Ct lwr extremity w/o&w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":264.9,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct lwr extremity w/o&w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73702","description":"Ct lwr extremity w/o&w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":49.3,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct lwr extremity w/o&w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73702","description":"Ct lwr extremity w/o&w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":215.6,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Contrast x-ray exam of colon","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"74280","description":"Contrast x-ray exam of colon","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":39.9,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Contrast x-ray exam of colon","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"74280","description":"Contrast x-ray exam of colon","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":65.1,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Contrast x-ray exam of colon","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"74280","description":"Contrast x-ray exam of colon","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":105.0,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ven thrombosis images bilat","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78458","description":"Ven thrombosis images bilat","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":37.2,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ven thrombosis images bilat","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78458","description":"Ven thrombosis images bilat","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":116.8,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ven thrombosis images bilat","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78458","description":"Ven thrombosis images bilat","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":153.9,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"CPT-70472","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70472","description":"CPT-70472","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":116.53,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"CPT-70472","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70472","description":"CPT-70472","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":28.46,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Vein x-ray liver","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"75891","description":"Vein x-ray liver","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":411.9,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Vein x-ray liver","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"75891","description":"Vein x-ray liver","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":365.8,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Vein x-ray liver","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"75891","description":"Vein x-ray liver","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":46.1,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Red cell survival study","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78130","description":"Red cell survival study","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":82.6,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Red cell survival study","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78130","description":"Red cell survival study","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":107.6,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Red cell survival study","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78130","description":"Red cell survival study","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":25.1,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Magnetic resonance (eg_ vibration) elastography","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"76391","description":"Magnetic resonance (eg_ vibration) elastography","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":56.04,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Magnetic resonance (eg_ vibration) elastography","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"76391","description":"Magnetic resonance (eg_ vibration) elastography","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":171.4,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Magnetic resonance (eg_ vibration) elastography","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"76391","description":"Magnetic resonance (eg_ vibration) elastography","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":56.04,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Magnetic resonance (eg_ vibration) elastography","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"76391","description":"Magnetic resonance (eg_ vibration) elastography","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":227.44,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Magnetic resonance (eg_ vibration) elastography","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"76391","description":"Magnetic resonance (eg_ vibration) elastography","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":227.44,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Magnetic resonance (eg_ vibration) elastography","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"76391","description":"Magnetic resonance (eg_ vibration) elastography","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":171.4,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Myocardial Imaging_ Positron Emission Tomography (Pet)_ Combined Perfusion With Metabolic Evaluation Study (Including Ventricular Wall Motion[S] And/Or Ejection Fraction[S]_ W","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78433","description":"Myocardial Imaging_ Positron Emission Tomography (Pet)_ Combined Perfusion With Metabolic Evaluation Study (Including Ventricular Wall Motion[S] And/Or Ejection Fraction[S]_ W","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":107.78,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Myocardial Imaging_ Positron Emission Tomography (Pet)_ Combined Perfusion With Metabolic Evaluation Study (Including Ventricular Wall Motion[S] And/Or Ejection Fraction[S]_ W","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78433","description":"Myocardial Imaging_ Positron Emission Tomography (Pet)_ Combined Perfusion With Metabolic Evaluation Study (Including Ventricular Wall Motion[S] And/Or Ejection Fraction[S]_ W","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":107.78,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI joint lwr extr w/o&w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73723","description":"MRI joint lwr extr w/o&w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":109.18,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI joint lwr extr w/o&w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73723","description":"MRI joint lwr extr w/o&w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":527.21,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI joint lwr extr w/o&w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73723","description":"MRI joint lwr extr w/o&w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":418.03,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Radiation physics consult","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77336","description":"Radiation physics consult","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":86.7,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Venography for congenital heart defect(s)_ including catheter placement_ and radiological supervision and interpretation; coronary sinus (List separately in addition to code f","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"93586","description":"Venography for congenital heart defect(s)_ including catheter placement_ and radiological supervision and interpretation; coronary sinus (List separately in addition to code f","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":53.62,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray upper gi&small intest","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"74245","description":"X-ray upper gi&small intest","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":106.2,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray upper gi&small intest","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"74245","description":"X-ray upper gi&small intest","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":69.3,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray upper gi&small intest","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"74245","description":"X-ray upper gi&small intest","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":36.9,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Guidance for radiaj tx dlvr","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77387","description":"Guidance for radiaj tx dlvr","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":28.25,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Guidance for radiaj tx dlvr","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77387","description":"Guidance for radiaj tx dlvr","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":28.25,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct angio abdominal arteries","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"75635","description":"Ct angio abdominal arteries","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":451.4,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct angio abdominal arteries","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"75635","description":"Ct angio abdominal arteries","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":548.8,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct angio abdominal arteries","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"75635","description":"Ct angio abdominal arteries","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":97.4,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"CPT-91125","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91125","description":"CPT-91125","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":110.52,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Radiopharmaceutical Quantification Measurement(S) Single Area (List Separately In Addition To Code For Primary Procedure)","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78835","description":"Radiopharmaceutical Quantification Measurement(S) Single Area (List Separately In Addition To Code For Primary Procedure)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":22.61,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Radiopharmaceutical Quantification Measurement(S) Single Area (List Separately In Addition To Code For Primary Procedure)","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78835","description":"Radiopharmaceutical Quantification Measurement(S) Single Area (List Separately In Addition To Code For Primary Procedure)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":100.73,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Radiopharmaceutical Quantification Measurement(S) Single Area (List Separately In Addition To Code For Primary Procedure)","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78835","description":"Radiopharmaceutical Quantification Measurement(S) Single Area (List Separately In Addition To Code For Primary Procedure)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":78.12,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Radiopharmaceutical Quantification Measurement(S) Single Area (List Separately In Addition To Code For Primary Procedure)","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78835","description":"Radiopharmaceutical Quantification Measurement(S) Single Area (List Separately In Addition To Code For Primary Procedure)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":78.12,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Radiopharmaceutical Quantification Measurement(S) Single Area (List Separately In Addition To Code For Primary Procedure)","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78835","description":"Radiopharmaceutical Quantification Measurement(S) Single Area (List Separately In Addition To Code For Primary Procedure)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":22.61,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Radiopharmaceutical Quantification Measurement(S) Single Area (List Separately In Addition To Code For Primary Procedure)","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78835","description":"Radiopharmaceutical Quantification Measurement(S) Single Area (List Separately In Addition To Code For Primary Procedure)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":100.73,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI lwr extremity w/o&w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73720","description":"MRI lwr extremity w/o&w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":108.83,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI lwr extremity w/o&w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73720","description":"MRI lwr extremity w/o&w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":418.03,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI lwr extremity w/o&w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73720","description":"MRI lwr extremity w/o&w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":526.86,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Serial salivary imaging","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78231","description":"Serial salivary imaging","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":113.4,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Serial salivary imaging","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78231","description":"Serial salivary imaging","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":21.3,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Serial salivary imaging","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78231","description":"Serial salivary imaging","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":92.2,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray exam of femur 2/>","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73552","description":"X-ray exam of femur 2/>","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":24.63,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray exam of femur 2/>","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73552","description":"X-ray exam of femur 2/>","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":7.58,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray exam of femur 2/>","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73552","description":"X-ray exam of femur 2/>","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":17.06,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Contrast x-ray exam of colon","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"74283","description":"Contrast x-ray exam of colon","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":74.5,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Contrast x-ray exam of colon","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"74283","description":"Contrast x-ray exam of colon","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":156.3,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Contrast x-ray exam of colon","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"74283","description":"Contrast x-ray exam of colon","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":81.8,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Radiation treatment delivery","billing_code_type":"HCPCS","billing_code_type_version":"2024","billing_code":"G6010","description":"Radiation treatment delivery","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":142.45,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Cardiac shunt imaging","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78428","description":"Cardiac shunt imaging","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":98.1,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Cardiac shunt imaging","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78428","description":"Cardiac shunt imaging","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":65.7,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Cardiac shunt imaging","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78428","description":"Cardiac shunt imaging","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":32.4,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Locm 300-399mg/ml iodine_1ml","billing_code_type":"HCPCS","billing_code_type_version":"2024","billing_code":"Q9967","description":"Locm 300-399mg/ml iodine_1ml","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":0.3,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Locm 300-399mg/ml iodine_1ml","billing_code_type":"HCPCS","billing_code_type_version":"2024","billing_code":"Q9967","description":"Locm 300-399mg/ml iodine_1ml","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":0.3,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Heart infarct image","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78466","description":"Heart infarct image","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":76.2,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Heart infarct image","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78466","description":"Heart infarct image","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":28.3,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Heart infarct image","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78466","description":"Heart infarct image","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":104.5,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Computer-aided detection_ including computer algorithm analysis of MRI image data for lesion detection/characterization_ pharmacokinetic analysis_ with further physician revie","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"0159T","description":"Computer-aided detection_ including computer algorithm analysis of MRI image data for lesion detection/characterization_ pharmacokinetic analysis_ with further physician revie","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":5.06,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Computer-aided detection_ including computer algorithm analysis of MRI image data for lesion detection/characterization_ pharmacokinetic analysis_ with further physician revie","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"0159T","description":"Computer-aided detection_ including computer algorithm analysis of MRI image data for lesion detection/characterization_ pharmacokinetic analysis_ with further physician revie","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":3.12,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Computer-aided detection_ including computer algorithm analysis of MRI image data for lesion detection/characterization_ pharmacokinetic analysis_ with further physician revie","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"0159T","description":"Computer-aided detection_ including computer algorithm analysis of MRI image data for lesion detection/characterization_ pharmacokinetic analysis_ with further physician revie","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":8.01,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Locm 200-299mg/ml iodine_1ml","billing_code_type":"HCPCS","billing_code_type_version":"2024","billing_code":"Q9966","description":"Locm 200-299mg/ml iodine_1ml","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":1.14,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Locm 200-299mg/ml iodine_1ml","billing_code_type":"HCPCS","billing_code_type_version":"2024","billing_code":"Q9966","description":"Locm 200-299mg/ml iodine_1ml","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":1.14,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct abd & pelvis w/o contrast","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"74176","description":"Ct abd & pelvis w/o contrast","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":101.07,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct abd & pelvis w/o contrast","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"74176","description":"Ct abd & pelvis w/o contrast","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":67.22,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct abd & pelvis w/o contrast","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"74176","description":"Ct abd & pelvis w/o contrast","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":168.29,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Echo guide for artery repair","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"76936","description":"Echo guide for artery repair","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":81.8,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Echo guide for artery repair","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"76936","description":"Echo guide for artery repair","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":183.0,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Echo guide for artery repair","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"76936","description":"Echo guide for artery repair","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":264.8,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Prgrmg dev eval impltbl sys","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"93260","description":"Prgrmg dev eval impltbl sys","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":72.19,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Prgrmg dev eval impltbl sys","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"93260","description":"Prgrmg dev eval impltbl sys","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":44.07,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Prgrmg dev eval impltbl sys","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"93260","description":"Prgrmg dev eval impltbl sys","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":28.12,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct upper extremity w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73201","description":"Ct upper extremity w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":46.9,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct upper extremity w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73201","description":"Ct upper extremity w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":171.7,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct upper extremity w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73201","description":"Ct upper extremity w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":218.6,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Magnetic resonance imaging_ breast_ without and with contrast material(s)_ including computer-aided detection (CAD real-time lesion detection_ characterization and pharmacokin","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77048","description":"Magnetic resonance imaging_ breast_ without and with contrast material(s)_ including computer-aided detection (CAD real-time lesion detection_ characterization and pharmacokin","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":105.79,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Magnetic resonance imaging_ breast_ without and with contrast material(s)_ including computer-aided detection (CAD real-time lesion detection_ characterization and pharmacokin","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77048","description":"Magnetic resonance imaging_ breast_ without and with contrast material(s)_ including computer-aided detection (CAD real-time lesion detection_ characterization and pharmacokin","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":105.79,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Magnetic resonance imaging_ breast_ without and with contrast material(s)_ including computer-aided detection (CAD real-time lesion detection_ characterization and pharmacokin","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77048","description":"Magnetic resonance imaging_ breast_ without and with contrast material(s)_ including computer-aided detection (CAD real-time lesion detection_ characterization and pharmacokin","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":105.79,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Magnetic resonance imaging_ breast_ without and with contrast material(s)_ including computer-aided detection (CAD real-time lesion detection_ characterization and pharmacokin","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77048","description":"Magnetic resonance imaging_ breast_ without and with contrast material(s)_ including computer-aided detection (CAD real-time lesion detection_ characterization and pharmacokin","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":105.79,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Magnetic resonance imaging_ breast_ without and with contrast material(s)_ including computer-aided detection (CAD real-time lesion detection_ characterization and pharmacokin","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77048","description":"Magnetic resonance imaging_ breast_ without and with contrast material(s)_ including computer-aided detection (CAD real-time lesion detection_ characterization and pharmacokin","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":105.79,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Hyperthermia treatment","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77610","description":"Hyperthermia treatment","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":63.4,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Hyperthermia treatment","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77610","description":"Hyperthermia treatment","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":152.0,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Hyperthermia treatment","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77610","description":"Hyperthermia treatment","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":88.6,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Brachytx isodose intermed","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77317","description":"Brachytx isodose intermed","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":251.64,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Brachytx isodose intermed","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77317","description":"Brachytx isodose intermed","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":93.19,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Brachytx isodose intermed","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77317","description":"Brachytx isodose intermed","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":344.83,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Brachytx isodose intermed","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77317","description":"Brachytx isodose intermed","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":344.83,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Brachytx isodose intermed","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77317","description":"Brachytx isodose intermed","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":251.64,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Brachytx isodose intermed","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77317","description":"Brachytx isodose intermed","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":93.19,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray exam of skull","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"70250","description":"X-ray exam of skull","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":27.9,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray exam of skull","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"70250","description":"X-ray exam of skull","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":18.2,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray exam of skull","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"70250","description":"X-ray exam of skull","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":9.7,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI fetal sngl/1st gestation","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"74712","description":"MRI fetal sngl/1st gestation","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":120.62,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI fetal sngl/1st gestation","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"74712","description":"MRI fetal sngl/1st gestation","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":323.55,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI fetal sngl/1st gestation","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"74712","description":"MRI fetal sngl/1st gestation","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":202.94,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct thorax w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"71260","description":"Ct thorax w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":255.8,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct thorax w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"71260","description":"Ct thorax w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":205.4,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct thorax w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"71260","description":"Ct thorax w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":50.4,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Gastric emptying imag study","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78265","description":"Gastric emptying imag study","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":246.65,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Gastric emptying imag study","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78265","description":"Gastric emptying imag study","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":38.56,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Gastric emptying imag study","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78265","description":"Gastric emptying imag study","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":285.21,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray exam of leg infant","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73592","description":"X-ray exam of leg infant","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":14.1,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray exam of leg infant","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73592","description":"X-ray exam of leg infant","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":20.6,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray exam of leg infant","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73592","description":"X-ray exam of leg infant","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":6.5,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Artery x-rays arms/legs","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"75716","description":"Artery x-rays arms/legs","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":419.2,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Artery x-rays arms/legs","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"75716","description":"Artery x-rays arms/legs","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":365.8,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Artery x-rays arms/legs","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"75716","description":"Artery x-rays arms/legs","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":53.4,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray nose to rectum","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"76010","description":"X-ray nose to rectum","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":14.9,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray nose to rectum","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"76010","description":"X-ray nose to rectum","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":7.4,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"X-ray nose to rectum","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"76010","description":"X-ray nose to rectum","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":22.3,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ob us < 14 wks addl fetus","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"76802","description":"Ob us < 14 wks addl fetus","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":66.3,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ob us < 14 wks addl fetus","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"76802","description":"Ob us < 14 wks addl fetus","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":34.2,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ob us < 14 wks addl fetus","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"76802","description":"Ob us < 14 wks addl fetus","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":32.1,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI joint of lwr extr w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73722","description":"MRI joint of lwr extr w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":81.93,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI joint of lwr extr w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73722","description":"MRI joint of lwr extr w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":391.24,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Myelography thoracic spine","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"72255","description":"Myelography thoracic spine","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":36.1,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI joint of lwr extr w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73722","description":"MRI joint of lwr extr w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":309.31,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Myelography thoracic spine","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"72255","description":"Myelography thoracic spine","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":125.6,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Myelography thoracic spine","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"72255","description":"Myelography thoracic spine","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":161.7,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct upper extremity w/o dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73200","description":"Ct upper extremity w/o dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":188.1,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct upper extremity w/o dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73200","description":"Ct upper extremity w/o dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":143.9,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Ct upper extremity w/o dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73200","description":"Ct upper extremity w/o dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":44.3,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Screening mammography_ bilateral (2-view study of each breast)_ including computer-aided detection (CAD) when performed","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77067","description":"Screening mammography_ bilateral (2-view study of each breast)_ including computer-aided detection (CAD) when performed","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":112.12,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Screening mammography_ bilateral (2-view study of each breast)_ including computer-aided detection (CAD) when performed","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77067","description":"Screening mammography_ bilateral (2-view study of each breast)_ including computer-aided detection (CAD) when performed","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":37.1,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Screening mammography_ bilateral (2-view study of each breast)_ including computer-aided detection (CAD) when performed","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77067","description":"Screening mammography_ bilateral (2-view study of each breast)_ including computer-aided detection (CAD) when performed","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":75.02,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Screening mammography_ bilateral (2-view study of each breast)_ including computer-aided detection (CAD) when performed","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77067","description":"Screening mammography_ bilateral (2-view study of each breast)_ including computer-aided detection (CAD) when performed","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":75.02,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Screening mammography_ bilateral (2-view study of each breast)_ including computer-aided detection (CAD) when performed","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77067","description":"Screening mammography_ bilateral (2-view study of each breast)_ including computer-aided detection (CAD) when performed","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":112.12,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Screening mammography_ bilateral (2-view study of each breast)_ including computer-aided detection (CAD) when performed","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"77067","description":"Screening mammography_ bilateral (2-view study of each breast)_ including computer-aided detection (CAD) when performed","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":37.1,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI upper extremity w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73219","description":"MRI upper extremity w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":391.59,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI upper extremity w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73219","description":"MRI upper extremity w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":309.31,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"MRI upper extremity w/dye","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"73219","description":"MRI upper extremity w/dye","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":82.28,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Right And Left Heart Catheterization For Congenital Heart Defect(S) Including Imaging Guidance By The Proceduralist To Advance The Catheter To The Target Zone(S); Abnormal Nat","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"93597","description":"Right And Left Heart Catheterization For Congenital Heart Defect(S) Including Imaging Guidance By The Proceduralist To Advance The Catheter To The Target Zone(S); Abnormal Nat","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":344.58,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Liver imaging","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78201","description":"Liver imaging","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":86.7,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Liver imaging","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78201","description":"Liver imaging","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":18.0,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["26"]}],"provider_references":[439136482]}]},
{"negotiation_arrangement":"ffs","name":"Liver imaging","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"78201","description":"Liver imaging","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":68.7,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient","billing_code_modifier":["TC"]}],"provider_references":[439136482]}]}]}
